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  • 1.
    Abrahamsen Grøndahl, Vigdis
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Hall-Lord, Marie-Louise
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Karlsson, Ingela
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Appelgren, Jari
    Karlstad University, Faculty of Economic Sciences, Communication and IT, Department of Economics and Statistics.
    Wilde Larsson, Bodil
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Exploring patient satisfaction predictors in relation to a theoretical model2013In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 26, no 1, p. 37-54Article in journal (Refereed)
  • 2.
    Alayed, Abdulrahman S.
    et al.
    Sophiahemmet Högskola, Sweden.
    Lööf, Helena
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Sophiahemmet Högskola, Sweden.
    Johansson, Unn-Britt
    Sophiahemmet Högskola, Sweden.
    Saudi Arabian ICU safety and nurses' attitudes2014In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 27, no 7, p. 581-593Article in journal (Refereed)
  • 3.
    Alayed, Abdulrahman S.
    et al.
    Sophiahemmet University.
    Lööf, Helena
    Sophiahemmet University.
    Johansson, Unn-Britt
    Sophiahemmet University.
    Saudi Arabian ICU safety and nurses' attitudes2014In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 27, no 7, p. 581-593Article in journal (Refereed)
  • 4.
    Dannapfel, Petra
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Poksinska, Bozena
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Thomas, Kristin
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Dissemination strategy for Lean thinking in health care2014In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 27, no 5, p. 391-404Article in journal (Refereed)
    Abstract [en]

    Purpose – The purpose of this paper is to contribute to knowledge about dissemination strategies for Lean thinking throughout multiple healthcare organisations.

    Design/methodology/approach – The Östergötland county council, Sweden (CCÖ ) was chosenas a case study for an healthcare Lean-thinking dissemination strategies. Document analysis and interviews were used and results were compared with similar strategies employed by staff at the National Health Service Institute for Innovation (NHSI) and improvement in Great Britain and the Odense University Hospital in Denmark.

    Findings – The Lean improvement programme was introduced to tackle challenges such as anageing society, rising care expectations and budgetary and economic constraints. It was designedas a long-term programme to create added value for patients and employee involvement. The dissemination strategy was: forming clear visions and objectives; piloting; training potential adopters; and formal dissemination. The CCÖ strategy was focused primarily on managers and was not meant to involve all staff until the implementation stage. Staff at the NHS attempted to address nurses’ needs during dissemination, which questioned whether the CCÖ managers’ dissemination strategy is sustainable.

    Practical implications – This paper inspires healthcare managers and decision makers who aim to disseminate Lean production in their organisations.

    Originality/value – There are many case studies describing Lean implementation in single healthcare organisations, but little is known about effective dissemination and implementation strategies in large healthcare systems. The authors, therefore, suggest activities for developing and implementing dissemination strategies in multiple healthcare organisations.

  • 5. dos Santos, MA
    et al.
    Tygessen, H
    Eriksson, H
    Herlitz, J
    University of Borås, School of Health Science.
    Clinical decision support system (CDSS)-effects on care quality.2014In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 27, no 8, p. 707-718Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Despite their efficacy, some recommended therapies are underused. The purpose of this paper is to describe clinical decision support system (CDSS) development and its impact on clinical guideline adherence. DESIGN/METHODOLOGY/APPROACH: A new CDSS was developed and introduced in a cardiac intensive care unit (CICU) in 2003, which provided physicians with patient-tailored reminders and permitted data export from electronic patient records into a national quality registry. To evaluate CDSS effects in the CICU, process indicators were compared to a control group using registry data. All CICUs were in the same region and only patients with acute coronary syndrome were included. FINDINGS: CDSS introduction was associated with increases in guideline adherence, which ranged from 16 to 35 per cent, depending on the therapy. Statistically significant associations between guideline adherence and CDSS use remained over the five-year period after its introduction. During the same period, no relapses occurred in the intervention CICU. PRACTICAL IMPLICATIONS: Guideline adherence and healthcare quality can be enhanced using CDSS. This study suggests that practitioners should turn to CDSS to improve healthcare quality. ORIGINALITY/VALUE: This paper describes and evaluates an intervention that successfully increased guideline adherence, which improved healthcare quality when the intervention CICU was compared to the control group.

  • 6.
    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, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 24, no 2, p. 101-123Article 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.

  • 7.
    Gadolin, Christian
    et al.
    University of Skövde, School of Business. University of Skövde, Enterprises for the Future.
    Andersson, Thomas
    University of Skövde, Enterprises for the Future. University of Skövde, School of Business.
    Healthcare quality improvement work: a professional employee perspective2017In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 30, no 5, p. 410-423Article in journal (Refereed)
    Abstract [en]

    Purpose

    The purpose of this paper is to describe and analyze conditions that influence how employees engage in healthcare quality improvement (QI) work.

    Design/methodology/approach

    Qualitative case study based on interviews (n=27) and observations (n=10).

    Findings

    The main conditions that influence how employees engage in healthcare QI work are professions, work structures and working relationships. These conditions can both prevent and facilitate healthcare QI. Professions and work structures may cement existing institutional logics and thus prevent employees from engaging in healthcare QI work. However, attempts to align QI with professional logics, together with work structures that empower employees, can make these conditions increase employee engagement, which can be accomplished through positive working relationships that foster institutional work, which bridge different competing institutional logics, making it possible to overcome barriers that professions and work structures may constitute.

    Practical implications

    Understanding the conditions that influence how employees engage in healthcare QI work will make initiatives more likely to succeed.

    Originality/value

    Healthcare QI has mainly been studied from an implementer perspective, and employees have either been neglected or seen as passive resisters. Weak employee perspectives make healthcare QI research incomplete. In our research, healthcare QI work is studied closely at the actor level to understand healthcare QI from an employee perspective.

  • 8.
    Holder, Magriet
    et al.
    Department of Business Management, University of Johannesburg, Johannesburg, South Africa.
    Berndt, Adele
    Jönköping University, Jönköping International Business School, JIBS, Marketing and Logistics.
    The effect of changes in servicescape and service quality perceptions in a maternity unit2011In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 24, no 5, p. 389-405Article in journal (Refereed)
    Abstract [en]

    Abstract

    Purpose: The aim of the research was to determine the effect of changes in servicescape on the service quality perceptions of maternity ward patients in a private hospital.

    Design/methodology/approach: A quasi-experimental design was used. An experimental and control group (of patients) were surveyed before the changes in servicescape took place, and a further experimental and control group of patients were surveyed after changes in the servicescape. Each group was surveyed using a SERVPERF instrument to determine perceptions of service quality.

    Findings: The changes in servicescape which took place in the experimental context resulted in a significant change in service quality perceptions among the experimental group. This change was not seen in all service quality dimensions, however, with statistical significance only seen in the tangible, reliability and responsiveness dimensions.

    Research limitations/implications: Four different groups of respondents took part in the quasi-experiment (two experimental groups and two control groups) specifically in a medical setting, and the ability to generalise these findings needs to be investigated.

    Practical implications: Management needs to take greater notice of the effect of servicescape, as well as any changes in the servicescape on the perceptions of service quality.

    Originality/value: While there is agreement that the servicescape affects perceptions of service quality, this study shows the effect of servicescape changes on perceptions of service quality.

  • 9.
    Häggström, Marie
    et al.
    Mittuniversitetet.
    Asplund, Kenneth
    Mittuniversitetet.
    Kristiansen, Lisbeth
    Mittuniversitetet.
    Important quality aspects in the transfer process2014In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 27, no 2, p. 123-139Article in journal (Refereed)
    Abstract [en]

    Purpose: Admission to and transfer from an intensive care unit affects not only the patient but also his or her relatives. The authors aimed to investigate relatives' perceptions of quality of care during a patient's transfer process from an intensive care unit to a general ward.

    Design/methodology/approach: The study had a mixed method design that included quantitative data and answers to open questions. The participants were 65 relatives of patients who received care in an ICU. They were recruited from two hospitals in Sweden.

    Findings: A majority perceived the transfer process as important, but analysis also showed that the participants rated it as an area for improvements. The relatives wanted participation, personal insight and control, respectful encounters, proximity, reassurance, continuous quality, reconnection and feedback. The relatives' participation in the transfer process was perceived as inadequate by 61 per cent, and the support that was received after the ICU discharge was perceived as inadequate by 53 per cent. The patients' length of stay in the ICU affected the relatives' perceptions of the quality of care. Overall, the relatives seemed to desire that the transfer process includes a continuous care, a competent staff, available information throughout the transfer process and personal involvement in the care, both before and after the transfer from the ICU.

    Research limitations/implications: The conclusion of this study is that relatives' needs and seeking for a well-planned ICU transitional process organisation with continuous quality before and after transfer, informational strategies that encourage the relatives to be involved and an organisation with competence throughout the healthcare chain are vital for quality.

    Practical implications: The conclusion of this study is that relatives' needs and seeking for a well-planned ICU transitional process organisation with continuous quality before and after transfer, informational strategies that encourage the relatives to be involved and an organisation with competence throughout the healthcare chain are vital for quality.

    Originality/value: The findings have important implications for nursing and nursing management. A relative's perception of the quality of care before and after transfer from ICU may be a valuable source to evaluate the ICU transitional care.

  • 10.
    Häggström, Marie
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Asplund, Kenneth
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Kristiansen, Lisbeth
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Important quality aspects in transfer process2014In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 27, no 2, p. 123-139Article in journal (Refereed)
    Abstract [en]

    Purpose: Admission to and transfer from an intensive care unit affects not only the patient but also his or her relatives. The authors aimed to investigate relatives' perceptions of quality of care during a patient's transfer process from an intensive care unit to a general ward. Design/methodology/approach: The study had a mixed method design that included quantitative data and answers to open questions. The participants were 65 relatives of patients who received care in an ICU. They were recruited from two hospitals in Sweden. Findings: A majority perceived the transfer process as important, but analysis also showed that the participants rated it as an area for improvements. The relatives wanted participation, personal insight and control, respectful encounters, proximity, reassurance, continuous quality, reconnection and feedback. The relatives' participation in the transfer process was perceived as inadequate by 61 per cent, and the support that was received after the ICU discharge was perceived as inadequate by 53 per cent. The patients' length of stay in the ICU affected the relatives' perceptions of the quality of care. Overall, the relatives seemed to desire that the transfer process includes a continuous care, a competent staff, available information throughout the transfer process and personal involvement in the care, both before and after the transfer from the ICU. Research limitations/implications: The conclusion of this study is that relatives' needs and seeking for a well-planned ICU transitional process organisation with continuous quality before and after transfer, informational strategies that encourage the relatives to be involved and an organisation with competence throughout the healthcare chain are vital for quality. Practical implications: The conclusion of this study is that relatives' needs and seeking for a well-planned ICU transitional process organisation with continuous quality before and after transfer, informational strategies that encourage the relatives to be involved and an organisation with competence throughout the healthcare chain are vital for quality. Originality/value: The findings have important implications for nursing and nursing management. A relative's perception of the quality of care before and after transfer from ICU may be a valuable source to evaluate the ICU transitional care.

  • 11.
    Jakobsson, Liselotte
    et al.
    Kristianstad University, School of Health and Society.
    Holmberg, Leif
    Kristianstad University, School of Health and Society.
    Individual personal relations: effects on service quality2011In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 24, no 6, p. 430-440Article in journal (Refereed)
    Abstract [en]

    PURPOSE:

    The purpose of this paper is to study patients' attitudes to nurses and investigate what hampering factors occur in the actual nursing situation and what patient features might affect cooperative climates.

    DESIGN/METHODOLOGY/APPROACH:

    In-depth interviews were conducted with 11 male inpatients suffering prostate cancer. The interviews were personal narrations based on open-ended questions. The theoretical basis is founded in sense-making, trust and competence.

    FINDINGS:

    Existential issues related to nursing care were interpreted by nurses as a need for (technical) information. However, respondents indicated a need for professional support regarding their whole life. The social climate seems not to be optimal for existential talk owing to hospital routines. Patients' personal traits also affect the propensity to cooperation, and three types were distinguished: cooperating patients; passive patients; and denying patients. Nurses' competence may be regarded as hierarchical levels from optimising single items, over system optimisation and to optimisation from the patient perspective. The study indicates that not even first-level requirements are met.

    RESEARCH LIMITATIONS/IMPLICATIONS:

    Only patients' views were studied. Nurses' perceptions would add additional insights. Lack of personal relations and cooperation between patient and nurse may decrease service quality. Patient attitudes seem to be a major obstacle. For some patients, passively receiving technical information may be an excuse for not wanting to participate in mutual sense-making. The supposed need for technical information may also be an excuse for nurses to avoid more sensitive issues.

    ORIGINALITY/VALUE:

    Better quality of care involves changing patient perceptions and attitudes to what constitutes nursing competence.

  • 12.
    Jakobsson, Liselotte
    et al.
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap.
    Holmberg, Leif
    Kristianstad University, School of Health and Society, Avdelningen för Ekonomi. Kristianstad University, Forskningsmiljön Organisatorisk Samverkan.
    Quality from the patient's perspective: a one-year trial2012In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 25, no 3, p. 177-188Article in journal (Refereed)
    Abstract [en]

    Purpose - Purpose - To study how changing information routines might influence patients’ service quality perceptions. A secondary aim was to test an instrument’s everyday feasibility for healthcare quality assessment.

    Design/methodology/approach - Patients often show high grade satisfaction with general care although they display dissatisfaction with information they receive. A questionnaire survey is used to establish pa-tients’ satisfaction with an intervention consisting of introducing standardized guidelines for nursing performance and information provision. Patient satisfaction was assessed through a standardized questionnaire: ‘Quality from the Patient’s Perspective’ (QPP). A cross sectional interventional survey was applied to patients from gynaecological and haematological wards (n=71). A comparison group was used (n=67). Patients were given the questionnaire when their diagnosis was confirmed, after six months and 12 months. Data were collected succes-sively over 36-months.

    Findings - Findings - The study group showed an increased satisfaction with information from nurses (p=0.001) but not physicians. However, patients tended to put greater emphasis on socio-cultural issues than information and some kind of cooperation seemed to represent high qual-ity from the patient’s perspective.

    Research limitations/implications - Limitations – Successively lower response rate, mainly owing to cancer patients’ deteriorating medical conditions.

    Practical implications - Implications for research, practice and/or society –The study seems to verify the concor-dance model’s relative merits and that the softer side of care appears to be more important to patients than specific improvements regarding information

    Originality/value - Value - Result confirm that patients’ satisfaction with information had implications for overall quality; but social issues seemed more important and enhancing quality is best achieved through participation and cooperation.

  • 13.
    Jansson von Vultée, Pia
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Axelsson, Runo
    Arnetz, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    The impact of organisational settings on physician wellbeing2007In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 20, no 6, p. 506-515Article in journal (Refereed)
    Abstract [en]

    Purpose – The purpose of this research is to show that the Swedish health care system has undergone major changes during the last decades, which have exerted strong influence on the operational freedom of physicians. Design/methodology/approach – This study consisted of 169 physicians in management positions, who answered a questionnaire assessing the relationship between their organizational settings and their perceived wellbeing. The organizational setting was defined as contact with top management, decision-making influence, well defined organization and whether the physician is acting as a leader. The perceived wellbeing was defined as social climate, work related exhaustion, work satisfaction, influence, development ability and supportive leadership. Findings – According to the results, organizational support improves work satisfaction and mental energy, and decreases work related exhaustion among physicians. This all leads to decreasing turnover rate among physicians. Originality/value – These results point to the importance of maintaining a positive and supportive atmosphere for physicians in their work environment in order to encourage physicians to remain and take on management positions in the health care system. Furthermore enhancing physician influence over decision making processes is important to counteract work-related exhaustion and it might also contribute to a more efficient organization.

  • 14. Johansson, Margareta
    et al.
    Rubertsson, Christine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Rådestad, Ingela
    Hildingsson, Ingegerd
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Improvements of postnatal care are required by Swedish fathers2013In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 26, no 5, p. 465-480Article in journal (Refereed)
    Abstract [en]

    PURPOSE:

    This paper has two main aims: to explore fathers' postnatal care experiences with a specific focus on deficiencies and to investigate which service deficiencies remained important for fathers one year after childbirth.

    DESIGN/METHODOLOGY/APPROACH:

    This is a prospective longitudinal study. Two months and one year after birth, the overall satisfaction with care were sought. A care quality index was created, based on perceived reality and subjective importance of the care given. The study excluded fathers not mastering Swedish. Total eligible fathers was consequently not known therefore pregnancies served as an estimate.

    FINDINGS:

    In total, 827 fathers answered the questionnaire two months after birth and 655 returned the follow-up questionnaire after one year; 21 per cent were dissatisfied with overall postnatal-care. The most important dissatisfying factors were the way fathers were treated by staff and the women's check-up/medical care. Two months after the birth, information given about the baby's care and needs were most deficient when parents had been cared for in a hotel ward. Furthermore, information about the baby's needs and woman's check-up/medical care was most deficient when fathers had participated in emergency Caesarean section.

    PRACTICAL IMPLICATIONS:

    Most fathers were satisfied with the overall postnatal care, but how fathers are treated by caregivers; the woman's check-up/medical care and information given about the baby's care and needs can be improved. Professionals should view early parenthood as a joint project and support both parents' needs.

    ORIGINALITY/VALUE:

    The paper provides knowledge about postnatal service quality including fathers' needs.

  • 15. Johansson, Margareta
    et al.
    Rubertsson, Christine
    Rådestad, Ingela
    Sophiahemmet University.
    Hildingsson, Ingegerd
    Improvements of postnatal care are required by Swedish fathers2013In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 26, no 5, p. 465-480Article in journal (Refereed)
    Abstract [en]

    Purpose – This paper has two main aims: to explore fathers' postnatal care experiences with a specific focus on deficiencies and to investigate which service deficiencies remained important for fathers one year after childbirth.

    Design/methodology/approach – This is a prospective longitudinal study. Two months and one year after birth, the overall satisfaction with care were sought. A care quality index was created, based on perceived reality and subjective importance of the care given. The study excluded fathers not mastering Swedish. Total eligible fathers was consequently not known therefore pregnancies served as an estimate.

    Findings – In total, 827 fathers answered the questionnaire two months after birth and 655 returned the follow-up questionnaire after one year; 21 per cent were dissatisfied with overall postnatal-care. The most important dissatisfying factors were the way fathers were treated by staff and the women's check-up/medical care. Two months after the birth, information given about the baby's care and needs were most deficient when parents had been cared for in a hotel ward. Furthermore, information about the baby's needs and woman's check-up/medical care was most deficient when fathers had participated in emergency Caesarean section.

    Practical implications – Most fathers were satisfied with the overall postnatal care, but how fathers are treated by caregivers; the woman's check-up/medical care and information given about the baby's care and needs can be improved. Professionals should view early parenthood as a joint project and support both parents' needs.

    Originality/value – The paper provides knowledge about postnatal service quality including fathers' needs.

  • 16.
    Johansson, Margareta
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Rubertsson, Christine
    Inst för Kvinnors och Barns hälsa, Department of Women's and Children's Health, Uppsala Universitet, Sweden.
    Rådestad, Ingela
    Department of Caring Sciences, Sophiahemmet University College, Sweden.
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Improvements of postnatal care are required by Swedish fathers2013In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 26, no 5, p. 465-480Article in journal (Refereed)
    Abstract [en]

    PURPOSE: This paper has two main aims: to explore fathers' postnatal care experiences with a specific focus on deficiencies and to investigate which service deficiencies remained important for fathers one year after childbirth.

    DESIGN/METHODOLOGY/APPROACH: This is a prospective longitudinal study. Two months and one year after birth, the overall satisfaction with care were sought. A care quality index was created, based on perceived reality and subjective importance of the care given. The study excluded fathers not mastering Swedish. Total eligible fathers was consequently not known therefore pregnancies served as an estimate.

    FINDINGS: In total, 827 fathers answered the questionnaire two months after birth and 655 returned the follow-up questionnaire after one year; 21 per cent were dissatisfied with overall postnatal-care. The most important dissatisfying factors were the way fathers were treated by staff and the women's check-up/medical care. Two months after the birth, information given about the baby's care and needs were most deficient when parents had been cared for in a hotel ward. Furthermore, information about the baby's needs and woman's check-up/medical care was most deficient when fathers had participated in emergency Caesarean section.

    PRACTICAL IMPLICATIONS: Most fathers were satisfied with the overall postnatal care, but how fathers are treated by caregivers; the woman's check-up/medical care and information given about the baby's care and needs can be improved. Professionals should view early parenthood as a joint project and support both parents' needs.

    ORIGINALITY/VALUE: The paper provides knowledge about postnatal service quality including fathers' needs.

  • 17.
    Kajonius, Petri J.
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Kazemi, Ali
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Advancing the Big Five of User-Oriented Elderly Care and Accounting for its Variations2016In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 29, no 2, p. 162-176Article in journal (Refereed)
    Abstract [en]

    Purpose – Care process quality (i.e., how care is enacted by a care worker toward a client at the interpersonal level) is a strong predictor of satisfaction in a wide range of health care services. The present research aims at describing the basic elements of care process quality as user-oriented care. Specifically, the questions of how and why quality in user-oriented care varies were investigated in the context of elderly care.

    Design – Two municipalities were selected for in-depth field studies. First, in each municipality, we interviewed and observed care workers’ interactions with the older persons in both home care and nursing homes during two weeks (Study 1). Second, in an attempt to gain a deeper understanding of why process quality in terms of user-oriented care varies, we conducted interviews with care workers and care unit managers (Study 2).

    Findings – A new taxonomy for categorising process quality variation, the Big Five of user-oriented care (Task-focus, Person-focus, Affect, Cooperation, and Time-use), is proposed. In addition, the perceived reasons for process quality variation are reported in our own developed Quality Agents Model, suggesting that variations in care process evaluations may be explained from different perspectives at multiple levels (i.e., older person, care worker-, unit-, department-, and municipality-level).

    Value – The proposed taxonomy and model are useful for describing user-oriented care quality and the reasons for its variations. These findings are of relevance for future quality developments of elderly care services, but also may be adapted to applications in any other enterprise employing a user-oriented approach.

    Keywords elderly care, quality, satisfaction, person-centered care, individualised care, user-oriented care

  • 18.
    Kajonius, Petri
    et al.
    University West, Department of Social and Behavioural Studies, Division of Psychology and Organisation Studies. Psykologiska Institutionen, Göteborgs Universitet.
    Kazemi, Ali
    School of Health and Education, University of Skövde, Skövde, Sweden.
    Advancing the Big Five of user-oriented elderly care and accounting for its variations2016In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 29, no 2, p. 162-176Article in journal (Refereed)
    Abstract [en]

    Purpose – Care process quality (i.e., how care is enacted by a care worker toward a client at the interpersonal level) is a strong predictor of satisfaction in a wide range of health care services. The present research aims at describing the basic elements of care process quality as user-oriented care. Specifically, the questions of how and why quality in user-oriented care varies were investigated in the context of elderly care.

    Design – Two municipalities were selected for in-depth field studies. First, in each municipality, we interviewed and observed care workers’ interactions with the older persons in both home care and nursing homes during two weeks (Study 1). Second, in an attempt to gain a deeper understanding of why process quality in terms of user-oriented care varies, we conducted interviews with care workers and care unit managers (Study 2).

    Findings – A new taxonomy for categorising process quality variation, the Big Five of user-oriented care (Task-focus, Person-focus, Affect, Cooperation, and Time-use), is proposed. In addition, the perceived reasons for process quality variation are reported in our own developed Quality Agents Model, suggesting that variations in care process evaluations may be explained from different perspectives at multiple levels (i.e., older person, care worker-, unit-, department-, and municipality-level).

    Value – The proposed taxonomy and model are useful for describing user-oriented care quality and the reasons for its variations. These findings are of relevance for future quality developments of elderly care services, but also may be adapted to applications in any other enterprise employing a user-oriented approach.

  • 19.
    Kjellström, Sofia
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Andersson, Ann-Christine
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Applying adult development theories to improvement science2017In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 30, no 7, p. 617-627Article in journal (Refereed)
    Abstract [en]

    Purpose

    The purpose of this paper is to address how adult development (AD) theories can contribute to quality improvement (QI).

    Design/methodology/approach

    A theoretical analysis and discussion on how personal development empirical findings can relate to QI and Deming's four improvement knowledge domains.

    Findings

    AD research shows that professionals have qualitatively diverse ways of meaning-making and ways to approach possibilities in improvement efforts. Therefore, professionals with more complex meaning-making capacities are needed to create successful transformational changes and learning, with the recognition that system knowledge is a developmental capacity.

    Practical implications

    In QI and improvement science there is an assumption that professionals have the skills and competence needed for improvement efforts, but AD theories show that this is not always the case, which suggests a need for facilitating improvement initiatives, so that everyone can contribute based on their capacity.

    Originality/value

    This study illustrates that some competences in QI efforts are a developmental challenge to professionals, and should be considered in practice and research.

  • 20. Larsson, G
    et al.
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Quality of care and patient satisfaction:: A new theoretical and methodological approach2010In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 23, no 2, p. 228-247Article in journal (Refereed)
  • 21.
    Larsson, Gerry
    et al.
    Swedish National Defence College, Department of Leadership and Management (ILM).
    Wilde-Larsson, Bodil
    Fakulteten för samhälls- och livsvetenskaper, Karlstad universitet .
    Quality of care and patient satisfaction: A new theoretical and methodological approach2010In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 23, no 2, p. 228-247Article in journal (Refereed)
  • 22.
    Lundqvist, Lars-Olov
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Rask, Mikael
    School of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
    Brunt, David
    School of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
    Ivarsson, Ann-Britt
    Örebro University, School of Health Sciences.
    Schröder, Agneta
    Örebro University, School of Health Sciences. Univ Orebro, Fac Med & Hlth, Univ Hlth Care Res Ctr, RNT, SE-70182 Orebro, Sweden..
    Measuring quality in community based housing support: the QPC-H instrument2016In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 29, no 3, p. 267-275Article in journal (Refereed)
    Abstract [en]

    Purpose - The purpose of this paper is to test the psychometric properties and dimensionality of the instrument Quality in Psychiatric Care-Housing (QPC-H) and briefly describe the residents' perception of quality of housing support. Design/methodology/approach - A sample of 174 residents from 22 housing support services in nine Swedish municipalities participated in the study. Confirmatory factor analysis (CFA) revealed that the QPC-H consisted of six dimensions and had a factor structure largely corresponding to that found among other instruments in the Quality in Psychiatric Care (QPC) family of instruments. Findings - CFA revealed that the QPC-H consisted of six dimensions and had a factor structure largely corresponding to that found among other instruments in the QPC family of instruments. The internal consistency of the factors was acceptable except in the case of secure and secluded environment, probably due to few numbers of items. With this exception, the QPC-H shows adequate psychometric properties. Social implications - The residents' ratings of quality of housing service were generally high; the highest rating was for secluded environment and the lowest for participation. This dimension would thus seem to indicate an important area for improvement. Originality/value - The QPC-H includes important aspects of residents' assessment of quality of housing service and offers a simple and inexpensive way to evaluate housing support services from the residents' perspective.

  • 23.
    Lundqvist, Lars-Olov
    et al.
    Örebro University.
    Rask, Mikael
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Brunt, David
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Ivarsson, Ann-Britt
    Örebro University.
    Schröder, Agneta
    Örebro University.
    Measuring quality in community based housing support: the QPC-H instrument2016In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 29, no 3, p. 267-275Article in journal (Refereed)
    Abstract [en]

    Purpose – The purpose of this paper is to test the psychometric properties and dimensionality of the instrument Quality in Psychiatric Care-Housing (QPC-H) and briefly describe the residents’ perception of quality of housing support. Design/methodology/approach – A sample of 174 residents from 22 housing support services in nine Swedish municipalities participated in the study. Confirmatory factor analysis (CFA) revealed that the QPC-H consisted of six dimensions and had a factor structure largely corresponding to that found among other instruments in the Quality in Psychiatric Care (QPC) family of instruments. Findings – CFA revealed that the QPC-H consisted of six dimensions and had a factor structure largely corresponding to that found among other instruments in the QPC family of instruments. The internal consistency of the factors was acceptable except in the case of secure and secluded environment, probably due to few numbers of items. With this exception, the QPC-H shows adequate psychometric properties. Social implications – The residents’ ratings of quality of housing service were generally high; the highest rating was for secluded environment and the lowest for participation. This dimension would thus seem to indicate an important area for improvement. Originality/value – The QPC-H includes important aspects of residents’ assessment of quality of housing service and offers a simple and inexpensive way to evaluate housing support services from the residents’ perspective. © 2016, © Emerald Group Publishing Limited.

  • 24.
    Nilsson, Petra
    et al.
    Kristianstad University, Forskningsmiljön Människa - Hälsa - Samhälle (MHS). Kristianstad University, School of Health and Society, Avdelningen för Oral hälsa och folkhälsovetenskap.
    Blomqvist, Kerstin
    Kristianstad University, Research Platform for Collaboration for Health. Kristianstad University, School of Health and Society, Avdelningen för Sjuksköterskeutbildningarna.
    Survey process quality: a question of healthcare manager approach2017In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 30, no 7, p. 591-602Article in journal (Refereed)
    Abstract [en]

    Purpose

    The purpose of this paper is to explore how healthcare first-line managers think about and act regarding workplace survey processes.

    Design/methodology/approach

    This interview study was performed at a hospital in south Sweden. First-line healthcare managers ( n=24) volunteered. The analysis was inspired by phenomenography, which aims to describe the ways in which different people experience a phenomenon. The phenomenon was a workplace health promotion (WHP) survey processes.

    Findings

    Four main WHP survey process approaches were identified among the managers: as a possibility, as a competition, as a work task among others and as an imposition. For each, three common subcategories emerged; how managers: stated challenges and support from hospital management; described their own work group and collaboration with other managers; and expressed themselves and their situation in their roles as first-line managers.

    Practical implications

    Insights into how hospital management can understand their first-line managers' motivation for survey processes and practical suggestions and how managers can work proactively at organizational, group and individual level are presented. Originality/value Usually these studies focus on those who should respond to a survey; not those who should run the survey process. Focusing on managers and not co-workers can lead to more committed and empowered managers and thereby success in survey processes.

  • 25.
    Nyström, Monica Elisabeth
    et al.
    Karolinska Institutet, Medical Management Centre.
    Garvare, Rickard
    Luleå University of Technology, Department of Business Administration, Technology and Social Sciences, Business Administration and Industrial Engineering.
    Westerlund, Anna
    Department of Public Health and Clinical Medicine, Umeå university.
    Weinehall, Lars
    Department of Public Health and Clinical Medicine, Umeå university.
    Concurrent Implementation of Quality Improvement Programs: Coordination or Conflict?2014In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 27, no 3, p. 190-208Article in journal (Refereed)
    Abstract [en]

    Purpose - Competing activities and projects can interfere with implementing new knowledge and approaches. The purpose, therefore, was to investigate processes and impact related to implementing two concurrent quality initiatives in a Swedish hospital. These were a regionally initiated, system-wide organizational learning programme called the Dynamic and Viable Organization (DVO) and a national initiative on stopping healthcare-associated and hospital-acquired infections (SHAI). Both undertakings aspired to increase staff competence in systematic improvement approaches.Design/methodology/approach - Multiple methods were applied including surveys, observations, interviews, process diaries, documents and organizational measurements. Respondents were unit managers, change facilitators and improvement team members.Findings - Even though both initiatives shared the same improvement approach, there was no strong indication that they were strategically combined to benefit each other. The initiatives existed side-by side with some coordination and some conflict. Despite absent management strategies to utilize the national SHAI initiative, positive developments in QI culture and communication were reported. The current study illustrates the inherent difficulties coordinating change initiatives, even in favourable circumstances.Research limitations/implications - The main implication is that special attention needs to be paid to competing activities during change processes, especially when launching large organizational change. A general organizational strategy on how to incrementally combine and coordinate change and development efforts might help to create a continuing organizational and quality-improvement process, and also save time and effort.Originality/value - This article addresses the lesser studied but common situation of coinciding and competing projects in organizations.

  • 26.
    Nyström, Monica
    et al.
    Karolinska Institutet, Medical Management Centre.
    Garvare, Rickard
    Westerlund, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Concurrent implementation of quality improvement programs. Coordination or conflict?2014In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 27, no 3, p. 190-208Article in journal (Refereed)
    Abstract [en]

    Purpose

    – Competing activities and projects can interfere with implementing new knowledge and approaches. The purpose, therefore, was to investigate processes and impact related to implementing two concurrent quality initiatives in a Swedish hospital. These were a regionally initiated, system-wide organizational learning programme called the Dynamic and Viable Organization (DVO) and a national initiative on stopping healthcare-associated and hospital-acquired infections (SHAI). Both undertakings aspired to increase staff competence in systematic improvement approaches.

    Design/methodology/approach

    – Multiple methods were applied including surveys, observations, interviews, process diaries, documents and organizational measurements. Respondents were unit managers, change facilitators and improvement team members.

    Findings

    – Even though both initiatives shared the same improvement approach, there was no strong indication that they were strategically combined to benefit each other. The initiatives existed side by side with some coordination and some conflict. Despite absent management strategies to utilize the national SHAI initiative, positive developments in QI culture and communication were reported. The current study illustrates the inherent difficulties coordinating change initiatives, even in favourable circumstances.

    Orginality/value

    – This article addresses the lesser studied but common situation of coinciding and competing projects in organizations.

  • 27.
    Sandin-Bojö, Ann-Kristin
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Kvist, JL
    Berg, M
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    What is, could be better: Swedish womens perceptions of their intrapartal care during planned vaginal birth2011In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 24, no 1, p. 81-95Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim of this study was to describe Swedish womens perceptions of the qualityof intrapartal care that they received and the subjective importance they ascribe to their care.Design: The study was nested within a Swedish national survey of intrapartal care. Thewomen whose care was investigated were invited to participate in the current study by themidwife who attended the birth. A total of 1173 women agreed to answer a questionnaireabout quality of general care and quality of specific intrapartal care two months postpartum. The questions were posed in two ways, perceived reality (PR) and subjectiveimportance (SI).Findings: 739 women (63%) returned their questionnaires. PR and SI for quality of generalcare were generally high (PR range 2.98 -3.81; SI range 2.85-3.85 , out of a possible 4) andfor quality of specific intrapartal care (PR range 3.15-3.86; SI range 3.23-3.86, out of apossible 4). Twelve items had statistically significantly higher scores for SI compared to PR.Eighty-one percent of the women fully or mostly agreed that the birth of their child was apositive experience.Orginality: The way in which questions about intrapartal care are posed is reflected in theway they are answered answers. In this study we have therefore asked not only how care wasperceived but also what importance individual women ascribed to different areas of their care.The questionnaire in this study allow identification of areas where what is, could be better.

  • 28. Schröder, A.
    et al.
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Ahlström, G.
    Quality in psychiatric care: an instrument evaluating patients' expectations and experiences2007In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 20, no 2, p. 141-160Article in journal (Refereed)
  • 29. Schröder, Agneta
    et al.
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Ahlström, Gerd
    Jönköping.
    Lundqvist, Lars-Olov
    Psychometric properties of the instrument Quality in Psychiatric Care and descriptions of quality of care among in-patients2010In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 23, no 6, p. 554-570Article in journal (Refereed)
    Abstract [en]

    Purpose – The purpose of this paper is to test the psychometric properties and dimensionality of a new instrument, quality in psychiatric care (QPC), and to describe and compare quality of care among in-patients as measured by this instrument.

    Design/methodology/approach – The instrument quality in psychiatric care measures patients' experiences regarding quality of care. The instrument is based on a definition of quality of care from the patients' perspective. A sample of 265 in-patients at eight general psychiatric wards in Sweden was assessed.

    Findings – Exploratory factor analysis revealed that the original five-dimensional 69-item QPC was better with six dimensions and reduced to 30 items, hereinafter denoted quality in psychiatric care-in-patients (QPC-IP) with retained internal consistency. The patients' ratings of quality of care were generally high; the highest rating was for quality of encounter and the lowest for participation.

    Research limitations/implications – Analysis of the dropouts was not possible because of incomplete registrations at the wards.

    Practical implications – QPC-IP is a simple, inexpensive and quick way to evaluate quality of care and thus contributes to health care improvement in the field of psychiatry.

    Originality/value – The new 30 items instrument, QPC-IP includes important aspects of patients' perceptions of quality of care. The QPC-IP is psychometrically adequate and thus recommended for evaluating patients' experiences of the quality of psychiatric care.

  • 30.
    Stankunas, M.
    et al.
    Department of Health Management, Lithuanian University of Health Sciences, Kaunas, Lithuania.
    Avery, M.
    Health Service Management Department, Centre for Health Innovation, School of Medicine, Griffith University, Southport, Australia.
    Lindert, J.
    Department of Public Health and Social Work, University of Applied Sciences Emden, Emden, Germany; Brandeis Women’s Research Center, Brandeis University, Waltham, United States.
    Edwards, I.
    Health Service Management Department, Centre for Health Innovation, School of Medicine, Griffith University, Southport, Australia.
    Di Rosa, M.D.
    Center for Socio-Economic Research on Ageing, Italian National Institute of Health and Science on Aging, Ancona, Italy.
    Torres-Gonzalez, F.
    Centro de Investigacion Biomedica en Red de Salud Mental, Department of Psychiatry, University of Granada, Granada, Spain.
    Ioannidi-Kapolou, E.
    Department of Sociology, National School of Public Health, Athens, Greece.
    Barros, H.
    Department of Epidemiology, Institute of Public Health, University of Porto, Porto, Portugal.
    Soares, Joaquim
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Healthcare and aging: Do European Union countries differ?2016In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 29, no 8, p. 895-906Article in journal (Refereed)
    Abstract [en]

    Purpose: The purpose of this paper is to evaluate socio-economic inequalities in the use, accessibility and satisfaction with health services amongst 60-84 year old people from seven European urban communities. Design/methodology/approach: Data for this study were collected in 2009. The target population was people aged 60-84 years from Stuttgart (Germany), Athens (Greece), Ancona (Italy), Kaunas (Lithuania), Porto (Portugal), Granada (Spain) and Stockholm (Sweden). The total sample comprised 4,467 respondents with a mean response rate across these countries of 45.2 per cent. Findings: The study demonstrated that the majority of respondents had contact with a health care provider within the last 12 months. The highest percentages were reported by respondents from Spain (97.8 per cent) and Portugal (97.7 per cent). The results suggest that 13.0 per cent of respondents had refrained from seeking care services. The highest rates were amongst seniors from Lithuania (24.0 per cent), Germany (16.2 per cent) and Portugal (15.4 per cent). Logistic regression suggests that seniors who refrained from seeking health care was statistically significant associated with those with higher levels of education (odds ratios (OR)=1.21; 95 per cent confidence intervals (CI)=1.01-1.25) and financial strain (OR=1.26; 95 per cent CI=1.16-1.37). Furthermore, the majority of respondents were satisfied with health care services. Originality/value: The findings from the “Elder Abuse: a multinational prevalence survey” study indicate the existence of significant variations in use, accessibility and satisfaction with health services by country and for socio-economic factors related to organizing and financing of care systems.

  • 31.
    Söderström, Eva
    et al.
    University of Skövde, School of Informatics. University of Skövde, The Informatics Research Centre.
    Eriksson, Nomie
    University of Skövde, School of Business. University of Skövde, Enterprises for the Future.
    Åhlfeldt, Rose-Mharie
    University of Skövde, School of Informatics. University of Skövde, The Informatics Research Centre.
    Managing healthcare information: analyzing trust2016In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 29, no 7, p. 786-800Article in journal (Refereed)
    Abstract [en]

    Purpose– The purpose of this paper is to analyze two case studies with a trust matrix tool, to identify trust issues related to electronic health records. Design/methodology/approach– A qualitative research approach is applied using two case studies. The data analysis of these studies generated a problem list, which was mapped to a trust matrix. Findings– Results demonstrate flaws in current practices and point to achieving balance between organizational, person and technology trust perspectives. The analysis revealed three challenge areas, to: achieve higher trust in patient-focussed healthcare; improve communication between patients and healthcare professionals; and establish clear terminology. By taking trust into account, a more holistic perspective on healthcare can be achieved, where trust can be obtained and optimized. Research limitations/implications– A trust matrix is tested and shown to identify trust problems on different levels and relating to trusting beliefs. Future research should elaborate and more fully address issues within three identified challenge areas. Practical implications– The trust matrix’s usefulness as a tool for organizations to analyze trust problems and issues is demonstrated. Originality/value– Healthcare trust issues are captured to a greater extent and from previously unchartered perspectives.

  • 32. Tolf, Sara
    et al.
    Nyström, Monica E
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Department of Learning Informatics, Management and Ethics, Karolinska Institutet, Stockholm.
    Tishelman, Carol
    Brommels, Mats
    Hansson, Johan
    Agile, a guiding principle for health care improvement?2015In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 28, no 5, p. 468-493Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The purpose of this paper is to contribute to increased understanding of the concept agile and its potential for hospital managers to optimize design of organizational structures and processes to combine internal efficiency and external effectiveness.

    DESIGN/METHODOLOGY/APPROACH: An integrative review was conducted using the reSEARCH database. Articles met the following criteria: first, a definition of agility; second, descriptions of enablers of becoming an agile organization; and finally, discussions of agile on multiple organizational levels. In total, 60 articles qualified for the final analysis.

    FINDINGS: Organizational agility rests on the assumption that the environment is uncertain, ranging from frequently changing to highly unpredictable. Proactive, reactive or embracive coping strategies were described as possible ways to handle such uncertain environments. Five organizational capacities were derived as necessary for hospitals to use the strategies optimally: transparent and transient inter-organizational links; market sensitivity and customer focus; management by support for self-organizing employees; organic structures that are elastic and responsive; flexible human and resource capacity for timely delivery. Agile is portrayed as either the "new paradigm" following lean, the needed development on top of a lean base, or as complementary to lean in distinct hybrid strategies.

    PRACTICAL IMPLICATIONS: Environmental uncertainty needs to be matched with coping strategies and organizational capacities to design processes responsive to real needs of health care. This implies that lean and agile can be combined to optimize the design of hospitals, to meet different variations in demand and create good patient management.

    ORIGINALITY/VALUE: While considerable value has been paid to strategies to improve the internal efficiency within hospitals, this review raise the attention to the value of strategies of external effectiveness.

  • 33. Ulfvarson, Johanna
    et al.
    Rahmner, Pia Bastholm
    Fastbom, Johan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Sjöviker, Susanne
    Karlsson, Eva Andersén
    Medication reviews with computerised expert support: evaluation of a method to improve the quality of drug utilisation in the elderly2010In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 23, no 6, p. 571-82Article in journal (Refereed)
    Abstract [en]

    PURPOSE: This paper aims to examine whether a computerised system for medication reviews can support physicians' decisions and improve the quality of drug treatment in the elderly.

    DESIGN/METHODOLOGY/APPROACH: This is a descriptive intervention study. The study included 275 patients living in community settings and nursing homes in Stockholm, Sweden. Patient data were analysed using computer software and scrutinised by a clinical pharmacologist. Pharmaco-therapeutic advice was sent to the physician responsible for each patient. The main outcome measures were initiation and discontinuation of drugs, changes of doses and rates of identified drug-related problems.

    FINDINGS: Expert opinions were given by the clinical pharmacologist, for 275 patients, mean age 85 years; 70 per cent female. An average of 3.3 remarks was given concerning unsuitable drugs, unclear indication, dosing when the kidney function was decreased, drug-drug interactions and quality indicators. On average 1.5 drug-related problems (DRP) per patient were attended to by the responsible physician at each unit. The most common action taken was withdrawal of a drug (n = 208). On average the drug use decreased from 10.4 to 9.5 drugs per patient, and several quality indicators were met. The drug costs decreased, and resulted in a more cost-effective drug therapy.

    ORIGINALITY/VALUE: The paper develops and tests a method for intervention in the care of elderly patients. The method is based on a computerised expert support system for medication reviews at a distance and on education of the staff. A safer drug therapy with improved quality and cost-effectiveness is thus provided.

  • 34.
    Wilde-Larsson, Bodil
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Inde, Marianne
    Landstinget i Värmland.
    Carlson, Annica
    Department of Surgery, Central Hospital, Karlstad, Sweden.
    Nordström, Gun
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Larsson, Gerry
    Department of Security, Strategy and Leadership, Swedish National Defence College, Karlstad, Sweden.
    Rystedt, Ingrid
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Implementation of patient-focused care: before-after effects2014In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 27, no 7, p. 594-604Article in journal (Refereed)
    Abstract [en]

    PurposeThe purpose of this paper is to evaluate an organizationally oriented, patient-focused care (PFC) model's effects on care quality and work climate. Design/methodology/approach The study has a before-after (PFC implementation) design. The sample included 1,474 patients and 458 healthcare providers in six participating wards before and after PFC implementation, plus five additional randomly chosen wards, which only featured in the post-assessment.FindingsNo pre-post differences were found regarding care perceptions or provider work climate evaluations. Statistically significant improvements were noted among provider care evaluations. Using aggregate-level ward data, multiple regression analyses showed that high adherence to PFC principles and a positive work climate contributed significantly to variance among care quality ratings. Research limitations/implications Among healthcare providers, questions related to specific PFC aspects during evenings, nights and weekends had to be dropped owing to a low response rate. Practical implications An important requirement for both practice and research is to tailor PFC to various health and social care contexts. Originality/valueThe study is large-scale before-after PFC model review, where patient and provider data were collected using well-established measurements.

  • 35.
    Wilde-Larsson, Bodil
    et al.
    Department of Health Sciences, Karlstad University, Karlstad, Sweden and Department of Public Health, Hedmark University College, Elverum, Norwa.
    Inde, Marianne
    Värmland County Council.
    Carlson, Annica
    Department of Surgery, Central Hospital, Karlstad, Sweden.
    Nordström, Gun
    Department of Health Sciences, Karlstad University, Karlstad, Sweden and Department of Public Health, Hedmark University College, Elverum, Norway.
    Larsson, Gerry
    Swedish National Defence College, Department of Security, Strategy and Leadership (ISSL), Ledarskapscentrum.
    Rystedt, Ingrid
    Department of Health Sciences, Karlstad University, Karlstad, Sweden.
    Implementation of patient-focused care: Before-after effects on work climate and quality of care in the eyes of patients and providers2014In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 27, p. 594-604Article in journal (Refereed)
    Abstract [en]

    Purpose– The purpose of this paper is to evaluate an organizationally oriented, patient-focused care (PFC) model's effects on care quality and work climate.

    Design/methodology/approach– The study has a before-after (PFC implementation) design. The sample included 1,474 patients and 458 healthcare providers in six participating wards before and after PFC implementation, plus five additional randomly chosen wards, which only featured in the post-assessment.

    Findings– No pre-post differences were found regarding care perceptions or provider work climate evaluations. Statistically significant improvements were noted among provider care evaluations. Using aggregate-level ward data, multiple regression analyses showed that high adherence to PFC principles and a positive work climate contributed significantly to variance among care quality ratings.

    Research limitations/implications– Among healthcare providers, questions related to specific PFC aspects during evenings, nights and weekends had to be dropped owing to a low response rate.

    Practical implications– An important requirement for both practice and research is to tailor PFC to various health and social care contexts.

    Originality/value– The study is large-scale before-after PFC model review, where patient and provider data were collected using well-established measurements.

  • 36.
    Wilde-Larsson, Bodil
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Inde, Marianne
    Värmland County Council, Karlstad, Sweden.
    Carlson, Annika
    Department of Surgery, Central Hospital, Karlstad, Sweden.
    Nordström, Gun
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Larsson, Gerry
    Swedish National Defence College.
    Rystedt, Ingrid
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Implementing patient-focused care: Before-after effects2014In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 27, no 7, p. 594-604Article, review/survey (Refereed)
    Abstract [en]

    Purpose

    The purpose of this paper is to evaluate an organizationally oriented, patient-focused care (PFC) model's effects on care quality and work climate.

    Design/methodology/approach

    The study has a before-after (PFC implementation) design. The sample included 1,474 patients and 458 healthcare providers in six participating wards before and after PFC implementation, plus five additional randomly chosen wards, which only featured in the post-assessment.

    Findings

    No pre-post differences were found regarding care perceptions or provider work climate evaluations. Statistically significant improvements were noted among provider care evaluations. Using aggregate-level ward data, multiple regression analyses showed that high adherence to PFC principles and a positive work climate contributed significantly to variance among care quality ratings.

    Research limitations/implications

    Among healthcare providers, questions related to specific PFC aspects during evenings, nights and weekends had to be dropped owing to a low response rate.

    Practical implications

    An important requirement for both practice and research is to tailor PFC to various health and social care contexts.

    Originality/value

    The study is large-scale before-after PFC model review, where patient and provider data were collected using well-established measurements.

  • 37.
    Wilde-Larsson, Bodil
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Larsson, G
    Patients' views on quality of care and attitudes towards revisiting the same provider2009In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 22, no 6, p. 600-611Article in journal (Refereed)
    Abstract [en]

    Winner at the Emerald Literati Network 2010. Highly Commended Award. Awards for Exellence

  • 38.
    Wilde-Larsson, Bodil
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Larsson, Gerry
    Department of Leadership and Management, Swedish National Defence College, Karlstad, Sweden.
    Wickman Chantereau, Marie
    Capio, Gothenburg, Sweden.
    Stael von Holstein, Karin
    Capio, Gothenburg, Sweden.
    International comparisons of patients' views on quality of care2005In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 18, no 1, p. 62-73Article in journal (Refereed)
    Abstract [en]

    Purpose – To compare patients’ views on quality of care in different countries using a theory-based instrument, while at the same time controlling for the following potential confounders: type of care system (private vs public), type of care (kind of health problem), gender, age, and subjective wellbeing.

    Design/methodology/approach – Patients capable of communicating in wards (medical and surgical departments) and day surgery departments in England, France, Norway, and Sweden were recruited consecutively, to participate in a programme run by the health-care company Capio. Ward patients: England (n =1,236), France (n =1,051), Norway (n =226), and Sweden (n =428). Day surgery patients: England (n =887), France (n =544), Norway (n =101), and Sweden (n =742). Average response rate across settings: approximately 75 per cent. Patients evaluated the quality of the care they actually received and the subjective importance they ascribed to different aspects of care. The questionnaire “Quality from the patient's perspective” (QPP) was used (modified short version).

    Findings – Cross-national comparisons were made within each of the two care contexts (wards and day surgery) separately for men and women. Quality of care evaluations were adjusted for age and subjective wellbeing. English and French patients scored significantly higher than Norwegian and Swedish on both kinds of ratings (perceived reality and subjective importance), in both kinds of care contexts, and in both sexes.

    Originality/value – Cross-national comparisons of patients’ views on care can give meaningful guidance for practitioners only if they are context-specific and if well-known confounders are controlled for.

  • 39.
    Zineldin, Mosad
    et al.
    Linnaeus University, Faculty of Business, Economics and Design, Linnaeus School of Business and Economics.
    Camgöz-Akdag, Hatice
    Kadir Has University, Turkey.
    Vasicheva, Valentina
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Social Work.
    Measuring, Evaluating and Improving Hospital Quality Parameters/Dimensions: An Integrated Healthcare Quality Approach2011In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 24, no 8, p. 654-662Article in journal (Refereed)
    Abstract [en]

    Purpose – This paper aims to examine the major factors affecting cumulative summation, to empirically examine the major factors affecting satisfaction and to address the question whether patients in Kazakhstan evaluate healthcare similarly or differently from patients in Egypt and Jordan.

    Design/methodology/approach – A questionnaire, adapted from previous research, was distributed to Kazakhstan inpatients. The questionnaire contained 39 attributes about five newly-developed quality dimensions (5Qs), which were identified to be the most relevant attributes for hospitals. The questionnaire was translated into Russian to increase the response rate and improve data quality. Almost 200 usable questionnaires were returned. Frequency distribution, factor analysis and reliability checks were used to analyze the data.

    Findings – The three biggest concerns for Kazakhstan patients are: infrastructure; atmosphere; and interaction. Hospital staff's concern for patients' needs, parking facilities for visitors, waiting time and food temperature were all common specific attributes, which were perceived as concerns. These were shortcomings in all three countries. Improving health service quality by applying total relationship management and the 5Qs model together with a customer-orientation strategy is recommended.

    Practical implications – Results can be used by hospital staff to reengineer and redesign creatively their quality management processes and help move towards more effective healthcare quality strategies.

    Social implications – Patients in three countries have similar concerns and quality perceptions.

    Originality/value – The paper describes a new instrument and method. The study assures relevance, validity and reliability, while being explicitly change-oriented. The authors argue that patient satisfaction is a cumulative construct, summing satisfaction as five different qualities (5Qs): object; processes; infrastructure; interaction and atmosphere.

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