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  • 2201.
    Wass, Sofie
    et al.
    Jönköping University, Jönköping International Business School, JIBS, Informatics.
    Vimarlund, Vivian
    Jönköping University, Jönköping International Business School, JIBS, Informatics. Jönköping University, Jönköping International Business School, JIBS, Centre for Information Technology and Information Systems (CenITIS). Linköping University, Linköping, Sweden.
    Business models in public eHealth2016In: 24th European Conference on Information Systems, ECIS 2016, 2016Conference paper (Refereed)
    Abstract [en]

    Several countries develop strategies and policies to foster the use of eHealth services and stress the importance of business models to develop and implement digital services. Previous research on business models has however mostly focused on the private setting or a healthcare setting with multi-payer or market-based financial systems. In this paper, we explore the use of business models in eHealth as well as the consistency of such a model in a public healthcare setting. The study is performed through a case study of an eHealth service and to which we apply a business model framework. Data have been collected through interviews, documents and project meetings. The results show that all parts of the business model could be identified and provide an overview of the service but no clear guidance on how to reach a sustainable value in the future. It seems that, in the case of public healthcare, there is a need to add the notion of a societal value as well as issues related to future governance for the diffusion of the service to make the business model and the service sustainable.

  • 2202.
    Wass, Sofie
    et al.
    Jönköping International Business School, Sweden.
    Vimarlund, Vivian
    Linköping University, Department of Computer and Information Science, Human-Centered systems. Linköping University, Faculty of Science & Engineering. Jönköping International Business School, Sweden.
    Challenges of Stimulating a Market for Social Innovation: Provision of a National Health Account2015In: Digital Healthcare Empowering Europeans / [ed] Ronald Cornet, Lăcrămioara Stoicu-Tivadar, Alexander Hörbst, Carlos Luis Parra Calderón, Stig Kjær Andersen, Mira Hercigonja-Szekeres, IOS Press, 2015, Vol. 210, p. 546-550Conference paper (Refereed)
    Abstract [en]

    Innovation in healthcare can be associated with social innovation and the mission to contribute to a shared value that benefits not only individuals or organizations but the society as a whole. In this paper, we present the prerequisites of stimulating a market for social innovations by studying the introduction of a national health account. The results show that there is a need to clarify if a national health account should be viewed as a public good or not, to clarify the financial responsibilities of different actors, to establish clear guidelines and to develop regulations concerning price, quality and certification of actors. The ambition to stimulate the market through a national health account is a promising start. However, the challenges have to be confronted in order for public and private actors to collaborate and build a market for social innovations such as a national health account.

  • 2203.
    Wass, Sofie
    et al.
    Jönköping University, Jönköping International Business School, JIBS, Informatics.
    Vimarlund, Vivian
    Jönköping University, Jönköping International Business School, JIBS, Informatics. Jönköping University, Jönköping International Business School, JIBS, Centre for Information Technology and Information Systems (CenITIS). Department of Computer Science, Linköping University, Sweden .
    Healthcare in the age of open innovation – A literature review2016In: Health Information Management Journal, ISSN 1833-3583, E-ISSN 1833-3575, Vol. 45, no 3, p. 121-133Article in journal (Refereed)
    Abstract [en]

    Background: In spite of an increased interest in open innovation and strategies that call for an increased collaboration between different healthcare actors, there is a lack of open innovation research in public contexts.

    Objective: This article presents the results of a review regarding the healthcare sector’s engagement in open innovation as well as constraining factors and positive outcomes of open innovation in healthcare.

    Method: The literature search focused on papers published in English between 2003 and 2014. Based on specified inclusion criteria, 18 articles were included.

    Results: Results reveal that most studies focus on inbound open innovation where external knowledge is integrated with the internal knowledge base at an initial phase of the innovation process. Innovation primarily results in products and services through innovation networks. We also identified constraining factors for open innovation in healthcare, including the complex organizations of healthcare, the need to establish routines for capturing knowledge from patients and clinicians, regulations and healthcare data laws as well as the positive outcome patient empowerment.

    Conclusion: The healthcare sector’s engagement in open innovation is limited, and it is necessary to perform further research with a focus on how open innovation can be managed in healthcare. 

  • 2204.
    Wass, Sofie
    et al.
    Jönköping University, Jönköping International Business School, JIBS, Informatics.
    Vimarlund, Vivian
    Jönköping University, Jönköping International Business School, JIBS, Informatics. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Linköping University, Sweden.
    Same, same but different: Perceptions of patients’ online access to electronic health records among healthcare professionals2018In: Health Informatics Journal, ISSN 1460-4582, E-ISSN 1741-2811Article in journal (Refereed)
    Abstract [en]

    In this study, we explore how healthcare professionals in primary care and outpatient clinics perceive the outcomes of giving patients online access to their electronic health records. The study was carried out as a case study and included a workshop, six interviews and a survey that was answered by 146 healthcare professionals. The results indicate that professionals working in primary care perceive that an increase in information-sharing with patients can increase adherence, clarify important information to the patient and allow the patient to quality-control documented information. Professionals at outpatient clinics seem less convinced about the benefits of patient accessible electronic health records and have concerns about how patients manage the information that they are given access to. However, the patient accessible electronic health record has not led to a change in documentation procedures among the majority of the professionals. While the findings can be connected to the context of outpatient clinics and primary care units, other contextual factors might influence the results and more in-depth studies are therefore needed to clarify the concerns.

  • 2205.
    Wass, Sofie
    et al.
    Jonkoping Univ, Sweden.
    Vimarlund, Vivian
    Linköping University, Department of Computer and Information Science, Human-Centered systems. Linköping University, Faculty of Science & Engineering. Jonkoping Univ, Sweden.
    The Role of ICT in Home Care2017In: CONTEXT SENSITIVE HEALTH INFORMATICS: REDESIGNING HEALTHCARE WORK, IOS PRESS , 2017, Vol. 241, p. 153-158Conference paper (Refereed)
    Abstract [en]

    With an ageing population and limited resources, ICT is often mentioned as a solution to support elderly people in maintaining an independent and healthy lifestyle. In this paper, we describe how ICT can support access to information and rationalization of work processes in a home care context. We do this by modelling the workflow and identifying the possible impact of ICT. The results show a complex process and indicate that the available resources are not used in the best possible way. The introduction of ICT could increase patient safety by reducing the risk of misplacing information about the care recipients and at the same time provide real time information about the care recipients needs and health at the point of care. However, to rationalize the work processes there is a need to combine ICT with a changed procedure for handling keys.

  • 2206.
    Wass, Sofie
    et al.
    Jönköping University, Jönköping International Business School, JIBS, Informatics.
    Vimarlund, Vivian
    Jönköping University, Jönköping International Business School, JIBS, Informatics. Jönköping University, Jönköping International Business School, JIBS, Centre for Information Technology and Information Systems (CenITIS). Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Department of Computer and Information Science, Linköping University, Sweden .
    The Role of ICT in Home Care2017In: Context Sensitive Health Informatics: Redesigning Healthcare Work / [ed] Christian Nøhr, Craig E. Kuziemsky, Zoie Shui-Yee Wong, IOS Press, 2017, Vol. 241, p. 153-158Conference paper (Refereed)
    Abstract [en]

    With an ageing population and limited resources, ICT is often mentioned as a solution to support elderly people in maintaining an independent and healthy lifestyle. In this paper, we describe how ICT can support access to information and rationalization of work processes in a home care context. We do this by modelling the workflow and identifying the possible impact of ICT. The results show a complex process and indicate that the available resources are not used in the best possible way. The introduction of ICT could increase patient safety by reducing the risk of misplacing information about the care recipients and at the same time provide real time information about the care recipients’ needs and health at the point of care. However, to rationalize the work processes there is a need to combine ICT with a changed procedure for handling keys.

  • 2207.
    Wass, Sofie
    et al.
    Jönköping University, Jönköping International Business School, JIBS, Informatics.
    Vimarlund, Vivian
    Jönköping University, Jönköping International Business School, JIBS, Informatics. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Department of Computer and Information Science/Human-Centered Systems, Linköping University, Sweden.
    The Role of PAEHRs in Patient Involvement2018In: Journal of medical systems, ISSN 0148-5598, E-ISSN 1573-689X, Vol. 42, no 11, article id 210Article in journal (Other academic)
    Abstract [en]

    With increased patient access to data, healthcare services are experiencing change where patients are moving away from being mere passive actors towards becoming more active and involved participants. In this paper, we explore the role of patient accessible electronic health records (PAEHRs) with respect to this increase in patient involvement. The study was performed as a case study and included nine interviews with patients and a survey that was responded to by 56 patients. Our results show that PAEHRs have a role in the enhancement of patient involvement because PAEHRs (i) foster a more balanced relationship between patients and healthcare professionals and (ii) increase access to information.

  • 2208.
    Waxegård, Gustaf
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology. Region of Kronoberg.
    Thulesius, Hans
    Lund University.
    Trust Testing in Care Pathways for Neurodevelopmental Disorders: A Grounded Theory Study2016In: The Grounded Theory Review, ISSN 1556-1542, E-ISSN 1556-1550, Vol. 15, no 1, p. 45-58Article in journal (Refereed)
    Abstract [en]

    Building care pathways for the expansive, heterogeneous, and complex field of neurodevelopmental disorders (ND) is challenging. This classic grounded theory study conceptualizes problems encountered and resolved by professionals in the unpacking— diagnosis and work up—of ND. A care pathway for ND in children and adolescents was observed for six years. Data include interviews, documentation of a dialogue-conference devoted to the ND care pathway, 100+ hours of participant observations, and coding of stakeholder actions. Trust testing explores whether professional unpacking collaboration can occur without being “stuck with the buck” and if other professionals can be approached to solve own unpacking priorities. ND complexity, scarce resources, and diverging stakeholder interests undermine the ability to make selfless collaborative professional choices in the care pathway. ND professionals and managers should pay as much attention to trust issues as they do to structures and patient flows. The trust testing theory may improve the understanding of ND care pathways further as a modified social dilemma framework. 

  • 2209.
    Weidlich, Diana
    et al.
    Catalyst Health Econ Consultants, England.
    Andersson, Fredrik L.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. Ferring Pharmaceut, Denmark.
    Oelke, Matthias
    Hannover Medical Sch, Germany.
    John Drake, Marcus
    Bristol Urol Institute, England.
    Fianu Jonasson, Aino
    Karolinska Institute, Sweden.
    Guest, Julian F.
    Catalyst Health Econ Consultants, England; Kings Coll London, England.
    Annual direct and indirect costs attributable to nocturia in Germany, Sweden, and the UK2017In: European Journal of Health Economics, ISSN 1618-7598, E-ISSN 1618-7601, Vol. 18, no 6, p. 761-771Article in journal (Refereed)
    Abstract [en]

    Our aim was to estimate the prevalence-based cost of illness imposed by nocturia (a 2 nocturnal voids per night) in Germany, Sweden, and the UK in an average year. Information obtained from a systematic review of published literature and clinicians was used to construct an algorithm depicting the management of nocturia in these three countries. This enabled an estimation of (1) annual levels of healthcare resource use, (2) annual cost of healthcare resource use, and (3) annual societal cost arising from presenteeism and absenteeism attributable to nocturia in each country. In an average year, there are an estimated 12.5, 1.2, and 8.6 million patients a 20 years of age with nocturia in Germany, Sweden, and the UK, respectively. In an average year in each country, respectively, these patients were estimated to have 13.8, 1.4, and 10.0 million visits to a family practitioner or specialist, similar to 91,000, 9000, and 63,000 hospital admissions attributable to nocturia and 216,000, 19,000, and 130,000 subjects were estimated to incur a fracture resulting from nocturia. The annual direct cost of healthcare resource use attributable to managing nocturia was estimated to be approximately a,notsign2.32 billion in Germany, 5.11 billion kr (a,notsign0.54 billion) in Sweden, and A 1.35 pound billion (a,notsign1.77 billion) in the UK. The annual indirect societal cost arising from both presenteeism and absenteeism was estimated to be approximately a,notsign20.76 billion in Germany and 19.65 billion kr (a,notsign2.10 billion) in Sweden. In addition, in the UK, the annual indirect cost due to absenteeism was an estimated A 4.32 pound billion (a,notsign5.64 billion). Nocturia appears to impose a substantial socioeconomic burden in all three countries. Clinical and economic benefits could accrue from an increased awareness of the impact that nocturia imposes on patients, health services, and society as a whole.

  • 2210.
    Weinehall, Lars
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Nyström, Monica
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Karolinska Institutet.
    Garvare, Rickard
    Luleå tekniska universitet.
    Johansson, Helene
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Kardakis, Therese
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Sundberg, Linda
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Höög, Elisabet
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Nyström, Berit
    Staben för verksamhetsutveckling, Västerbottens läns landsting.
    Nationella Riktlinjer för vårdens hälsofrämjande arbete: utmaningen att gå från evidens till klinisk tillämpning. Slutrapport från Vinnvårdsprojekt A2008-0252014Report (Other academic)
  • 2211.
    Wellander, Annika
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Att vara syskon till barn med cancer: En systematisk litteraturstudie om syskons erfarenheter av att ha en bror eller syster med cancer2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Årligen insjuknar ca 300 barn i någon form av cancer i Sverigel. När ett barn drabbas av cancer, påverkar det hela familjen. Hur det påverkar och vilka erfarenheter det ger de friska syskonen finns det en okunskap om. Syfte: Att belysa erfarenheter av att vara ett syskon till barn med cancer. Metod: Systematiska litteraturstudie byggd på tre kvantitativa och fem kvalitativa artiklar. Sökning gjordes i Cinahl, PubMed och PsykINFO. Artiklarna har kvalitetsgranskats och inspiration av innehållsanalys anvädes. Resultat: Analysen resulterade i två huvudkategorier. Första huvudkategorin var förändrat välbefinnande med underkategorier: fysiska-,emotionella- och sociala förändringar. Den andra huvudkategorin var förutsättningar för att hantera erfarenheterna med underkategorier: copingstrategier, kunskap, socialt stöd och hopp. Resultatet visade att syskonen är beroende av varandra. Okunskap om cancer och vad som händer med det sjuka syskonet ökar bland annat oro, ångest hos det frsiaka syskonet. Information är viktig för hela familjen, även syskonen. Slutsatser: Resultatet visar att syskon till barn med cancer upplever flera olika förändringar inom de negativa aspekterna. De påverkas också positivt när de får kunskap och information om cancer. Sjukvårdspersonal behöver bli bättre på att uppmärksamma och stödja syskonen när deras syskon fått cancer. Genom ett holistiskt synsätt som t.e.x familjefokuserad omvårdnad.

  • 2212. Wellander, Lisa
    et al.
    Wells, Michael B.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Feldman, Inna
    Does Prevention Pay? Costs and Potential Cost-savings of School Interventions Targeting Children with Mental Health Problems2016In: Journal of Mental Health Policy and Economics, ISSN 1091-4358, E-ISSN 1099-176X, Vol. 19, no 2, p. 91-101Article in journal (Refereed)
    Abstract [en]

    Background: In Sweden, the local government is responsible for funding schools in their district. One funding initiative is for schools to provide students with mental health problems with additional support via extra teachers, personal assistants, and special education classes. There are evidence-based preventive interventions delivered in schools, which have been shown to decrease the levels of students' mental health problems. However, little is known about how much the local government currently spends on students' mental health support and if evidence-based interventions could be financially beneficial. Aims of the Study: The aim of this study was to estimate the costs of providing additional support for students' mental health problems and the potential cost-offsets, defined as reduced school-based additional support, if two evidence-based school interventions targeting children's mental health problems were implemented in routine practice. Methods: This study uses data on the additional support students with mental health problems received in schools. Data was collected from one school district for students aged 6 to 16 years. We modeled two Swedish school interventions, Comet for Teachers and Social and Emotional Training (SET), which both had evidence of reducing mental health problems. We used a cost-offset analysis framework, assuming both interventions were fully implemented throughout the whole school district. Based on the published studies, the expected effects and the costs of the interventions were calculated. We defined the cost-offsets as the amount of predicted averted additional support for students with ongoing mental health problems who might no longer require receiving services such as one-on-one time with an extra teacher, a personal assistant, or to be placed in a special education classroom. A cost-offset analysis, from a payer's perspective (the local government responsible for school financing), was conducted comparing the costs of both interventions with the potential cost-savings due to a reduction in the prevalence of mental health problems and averted additional support required. Results: The school district was comprised of 6,256 students, with 310 students receiving additional support for their mental health problems. Of these, 143 received support in their original school due to either having ADHD (n = 111), psychosocial problems (n = 26), or anxiety/depression (n = 6). The payers' total cost of additional support was 2,637,850 Euro per school year (18,447 Euro per student). The cost of running both interventions for the school district was 953,643 Euro for one year, while the potential savings for these interventions were estimated to be 627,150 Euro. The estimated effects showed that there would be a reduction of students needing additional support (25 for ADHD, eight for psychosocial problems, and one for anxiety/depression), and the payer would receive a return on their invested resources in less than two years (1.5 years) after implementation. Discussion: Preventive school interventions can both improve some children's mental health problems and be financially beneficial for the payer. However, they are still limited in their scope of reducing all students' mental health statuses to below clinical cut-offs; therefore, the preventive school interventions should be used as a supplement, but not a replacement, to current practices. Implications for Health Policies: The findings have political and societal implications, in that payers can reallocate their funds toward preventive measures targeting students' mental health problems, while reducing the costs. Implications for Future Research: When evaluating public health actions, it is necessary to consider their economic impact. The resources are scarce and the decision makers need knowledge on how to allocate their resources in an efficient way. Cost-offset analysis is seen as one way for decision makers to comprehend research findings; however, such analyses tend to not include the full benefits of the interventions, and actual impacts need to be fully evaluated in routine implementation.

  • 2213.
    Wellander, Lisa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Wells, Michael B.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Does Prevention Pay?: Health and Economic Impact of Preventive Interventions for School Children Aimed to Improve Mental Health2015In: Journal of Mental Health Policy and Economics, ISSN 1091-4358, E-ISSN 1099-176X, Vol. 18, no S1, p. S39-S40Article in journal (Other academic)
  • 2214.
    Weman-Josefsson, Karin Anna
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    "e" som i engagemang?: Bilaga till etappen ”Framtidens friskvård, egenvård och jobbhälsa” inom Opinion Hälsa, april 20132013Report (Other (popular science, discussion, etc.))
  • 2215.
    Weman-Josefsson, Karin
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Wärnestål, Pontus
    Halmstad University, School of Information Technology, Halmstad Embedded and Intelligent Systems Research (EIS), Man and Information technology laboratory (MI-lab).
    Johnson, Urban
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Halila, Fawzi
    Halmstad University, School of Business, Engineering and Science, Centre for Innovation, Entrepreneurship and Learning Research (CIEL).
    Wickström, Nicholas
    Halmstad University, School of Information Technology, Halmstad Embedded and Intelligent Systems Research (EIS), CAISR - Center for Applied Intelligent Systems Research.
    An interdisciplinary project plan on Digital Innovations and Self-determined Exercise Motivation2013Conference paper (Other academic)
  • 2216.
    Wennberg, Pär
    et al.
    Örebro University, School of Health Sciences. Research and Development Centre, Skaraborg Hospital, Skövde, Sweden; Centre for Health Care Sciences, Örebro County Council, Örebro, Sweden.
    Andersson, Henrik
    PreHospen - Centre for Prehospital Research, University of Borås, Borås, Sweden; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.
    Wireklint Sundström, Birgitta
    PreHospen - Centre for Prehospital Research, University of Borås, Borås, Sweden; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.
    Patients with suspected hip fracture in the chain of emergency care: An integrative review of the literature2018In: International Journal of Orthopaedic and Trauma Nursing, ISSN 1878-1241, E-ISSN 1878-1292, Vol. 29, p. 16-31Article, review/survey (Refereed)
  • 2217.
    Wenzel, Helmut
    et al.
    Health Economist, Konstanz, Germany.
    Jansson, Stefan P. O.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Family Medicine, Brickebacken Primary Health Care Center, Örebro, Sweden.
    Landin-Olsson, Mona
    Department of Endocrinology, Lund University Hospital, Lund, Sweden.
    Integrated Diabetes Care in Sweden2017In: Integrated Diabetes Care: A Multidisciplinary Approach / [ed] David Simmons, Helmut Wenzel, Janice C. Zgibor, Springer, 2017, p. 201-214Chapter in book (Other academic)
    Abstract [en]

    The Swedish health-care system is a kind of “Beveridge model”, with a strong orientation towards subnational levels, i.e. municipalities and regions. The responsibility is shared between the central government, county councils and municipalities. Health care is mainly tax funded both at the Government level and the levels of the county councils and the municipalities. The latter also levy proportional income taxes on the population to cover the services that they provide. In addition, small user fees are paid at the point of use. The health system is highly decentralised and organised: this leads to variation in care provision. To overcome this, the government has created national guidelines for common diagnoses including diabetes. Primary and secondary care is funded and delivered at county level. Municipalities are responsible for nursing and residential homes as well as home care and other social services. The Swedish health-care system is trying to combine decentralisation, a high degree of specialisation, and professional organisation in a system where common health-care goals can be maintained. To avoid fragmentation, ‘chains of care’ have been identified to bridge different care givers. Diabetes is treated by multidisciplinary teams consisting of doctors and diabetes nurses in collaboration with other professionals at primary or secondary care level. This means that virtually all patients with type 1 diabetes have their care provided at hospitals, while patients with type 2 diabetes are managed in primary care. Electronic medical records (EMR) are used by the majority of care givers, and are linked to the National Diabetes Register (NDR) as well as to other national registers. EMR are also used for referrals within or between county councils. For patients without complications the level of care and allocated resources can be defined by national guidelines. For patients with complications the care involves specialist units at the hospital in collaboration with primary care and medical assistance in the home. These chains of care are more difficult to define but instead the government has defined quality indicators in order to keep the frequency of complications as low as possible.

  • 2218.
    Werntoft, Elisabet
    et al.
    Lunds universitet.
    Edberg, Anna-Karin
    Lunds universitet.
    The views of physicians and politicians concerning age-related prioritisation in healthcare.2009In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 23, no 1, p. 38-52Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The aim of this study is to describe the view of age-related prioritisation in health care among physicians and healthcare politicians and to compare their views regarding gender and age.

    DESIGN/METHODOLOGY/APPROACH: Swedish physicians (n=390) and politicians (n=310), mean age 52 years, answered an electronic questionnaire concerning age-related priority setting in healthcare. The questionnaire had fixed response alternatives with possibility of adding comments.

    FINDINGS: A majority of the participants thought that age should not influence prioritisation, although more physicians than politicians thought that younger patients should be prioritised. There were also significant differences concerning their views on lifestyle-related diseases and on who should make decisions concerning both vertical and horizontal prioritisation. The comments indicated that the politicians referred to ethical principles as a basis for their standpoints while the physicians often referred to the importance of biological rather than chronological age.

    RESEARCH LIMITATIONS/IMPLICATIONS: Web-based surveys as a method has its limitations as biased samples and biased returns could cause major problems, such as limited control over the drop-outs. The sample in this study was, however, judged to be representative.

    PRACTICAL IMPLICATIONS: The results indicate that supplementary guiding principles concerning prioritisation in healthcare are needed in order to facilitate decision-making concerning resource allocation on a local level.

    ORIGINALITY/VALUE: This paper adds important knowledge about decision makers' views on age-related priorities in healthcare, thus contributing to scientific base for prioritisation in healthcare and the ongoing debate in society.

  • 2219.
    Werntoft, Elisabet
    et al.
    Lunds universitet.
    Rahm Hallberg, Ingalill
    Lunds universitet.
    Elmståhl, Sölve
    Lunds Universitet.
    Edberg, Anna-Karin
    Lunds universitet.
    Older people's views on how to finance increasing health-care costs2006In: Ageing & Society, ISSN 0144-686X, E-ISSN 1469-1779, Vol. 26, no 3, p. 497-514Article in journal (Refereed)
    Abstract [en]

    The aims of this paper are to investigate both older people's views about ways in which to finance health-care costs and their willingness to pay for treatment themselves, along with variations in these views by age and gender. The data are from the Good Ageing in Skåne (GAS) prospective longitudinal cohort study in Sweden, which involved medical examinations and a survey of living arrangements and socio-economic conditions. For the analysis reported in this paper, 930 GAS respondents aged 60–93 years were invited to participate in an additional structured interview, and 902 (97%) accepted. The sample was divided into the ‘young-old’ (aged 60–72 years), ‘old-old’ (78–84 years) and ‘oldest-old’ (87–93 years). It was found that the participants recommended increasing health-care funding by higher taxes and that they were willing to pay themselves for specific treatments, e.g. cosmetic surgery and medication to combat impotence and obesity. Many were also willing to pay privately for cataract surgery, to shorten the wait, although the respondent's financial circumstances associated with this willingness. Significantly more men than women, and of the ‘young-old’ than of the other two age groups, would pay for cataract surgery. The views of people aged 85 or more years differed from those of the young-old, e.g. significantly fewer believed that older people's health care received too little resource. Views about how to finance health care thus differed among the age groups and between men and women.

  • 2220. Wesseling, Catharina
    et al.
    Aragón, Aurora
    Elgstrand, Kaj
    KTH, School of Industrial Engineering and Management (ITM), Industrial Ecology.
    Flores, Reinaldo
    Hogstedt, Christier
    Partanen, Timo
    SALTRA: A Regional Program for Workers' Health and Sustainable Development in Central America2011In: International journal of occupational and environmental health, ISSN 1077-3525, E-ISSN 2049-3967, Vol. 17, no 3, p. 223-229Article in journal (Refereed)
    Abstract [en]

    In 2003, the university-based Program on Work and Health in Central America, SALTRA, was launched to build national and regional capacities in occupational safety and health with the goal of preventing and reducing poverty in Central America. SALTRA has implemented 20 projects including action projects in priority sectors (e.g., construction, sugarcane, hospitals, migrant coffee workers); strengthening of surveillance (occupational health profiles, carcinogenic exposures, fatal injuries and pesticides); a participatory model for training and risk monitoring by workers; building occupational health capacity for professionals, employers, and workers, with collaborating networks between the countries; strengthening of universities in work, environment, and health; studies of serious occupational and environmental situations; communication channels; and continued efforts to raise political awareness. SALTRA has placed issues of workers' health on political, business, and academic agendas throughout the region and has laid the foundations for achieving substantial future improvements in health conditions of all workers in the region. External evaluators envisioned SALTRA as an innovative development model.

  • 2221.
    Westerberg, Ingvar
    Linköping University, Department of Thematic Studies. Linköping University, Faculty of Arts and Sciences.
    Produktion, produktivitet och kostnader i svensk tandvård1987Doctoral thesis, monograph (Other academic)
    Abstract [en]

    The thesis contains projects at a national as well as a clinical level.

    On a national level a study is made of productivity in adult dental care in both its private and its public·sectors. By using the calculated productivity for the years 1975-1984 a variety of factors are tested for the ability to explain firstly the development of productivity in private dental care and in public dental care respectively, and secondly the differences in productivity between the two sectors.

    The productivity measures used are the number of patients treated per dentist hour and the dentist fee per dentist hour. The results show in the case of the first mentioned productivity measure a somewhat higher value for public dental care for all of the years studied. For the productivity measures, dentist's fee per dentist hour, private dental care shows a 20-30 percent higher productivity.

    Differences in the age structure of the patients and different treatment panoramas can explain a great many of the differences in productivity. However the question is why the treatment panoramas of the two sectors are so different, a difference that can scarcely be explained by differences in the patient population. There are grounds, therefore, for believing that the differences can be explained on the basis of differences in the activity goals of the two sectors.

    As a complement to the productivity studies outlined above the costs of treating a patient have also been compared. The results show considerably higher costs in public dental care, though the difference has been greatly reduced during the 80s due largely to a lower rate of increase in the overheads of dentists in the public sector over the last few years.

    The second study comprises a production economic study of 144 public dental care clinics in five counties in southern Sweden. The variation in productivity is tested on the basis of various explanatory factors using multiple regression analysis according to OLS. The regression models used were a linear function, an exponential function of the Cobb-Douglas type as well as a transcendental function of the type first formulated by Reinhardt in 1972. The results show that the high productivity clinic is smaller (1-2 dentists), has a larger staff of assistants, has fewer children and adolescents among its patients and shows higher productivity also in the case of the other productivity measure.

    The study also contains an estimation of the production function for the 144 clinics. A Cobb-Douglas production function is used as a regression mode. The results point to significant estimated coefficient values for all production factors. The coefficient values are, as could be expected, positive and between zero and one in size. The results are in agreement with most of the estimations obtained from previous studies.

  • 2222.
    Westerberg, Kristina
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Tafvelin, Susanne
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Changes in commitment to change among leaders in home help services2015In: Leadership in Health Services, ISSN 1751-1879, E-ISSN 1751-1887, Vol. 28, no 3, p. 216-227Article in journal (Refereed)
    Abstract [en]

    Purpose: The purpose of the this study was to explore the development of commitment to change among leaders in the home help services during organizational change and to study this development in relation to workload and stress. During organizational change initiatives, commitment to change among leaders is important to ensure the implementation of the change. However, little is known of development of commitment of change over time. Design/methodology/approach: The study used a qualitative design with semi-structured interviews with ten leaders by the time an organizational change initiative was launched and follow-up one year later. Thematic content analysis was used to analyze the interviews. Findings: Commitment to change is not static, but seems to develop over time and during organizational change. At the first interview, leaders had a varied pattern reflecting different dimensions of commitment to change. One year later, the differences between leaders’ commitment to change was less obvious. Differences in commitment to change had no apparent relationship with workload or stress. Research limitations/implications: The data were collected from one organization, and the number of participants were small which could affect the results on workload and stress in relation to commitment to change. Practical implications: It is important to support leaders during organizational change initiatives to maintain their commitment. One way to accomplish this is to use management team meetings to monitor how leaders perceive their situation. Originality/value: Qualitative, longitudinal and leader studies on commitment to change are all unusual, and taken together, this study shows new aspects of commitment.

  • 2223.
    Westergren, Robert
    et al.
    Jönköping University, School of Health and Welfare, HHJ. Prosthetics and Orthotics.
    Nasser, Mehdi
    Jönköping University, School of Health and Welfare, HHJ. Prosthetics and Orthotics.
    Patient satisfaction and mobility with their assistive device and service2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Objective: To gather knowledge related to patient satisfaction and mobility with lower limb prosthetic and orthotic devices and to investigate satisfaction with services received. Another purpose of this study is to analyze potential differences between orthotic and prosthetic patients in relation to patient satisfaction and mobility.

    Design: Cross-sectional study

    Subjects: 21 participants with a mean age of 58 (SD 16) with an average duration of use of devices of 10 (SD 10) years. 12 out of the 21 participants were orthotic users and 9 were prosthetic users.

    Methods: Patients were asked to complete two questionnaires, one regarding satisfaction with assistive device and service (QUEST 2.0) and one regarding mobility.

    Results: Patients mean score regarding satisfaction with assistive device and service were 4.0 (SD 0.8) and 4.2 (SD 1.0) respectively. 91% reported that they had the ability to walk at least 100 meters with their assistive device. The areas where participants experienced most difficulties were walking on uneven ground (70%), walking up and down a hill (57%) and walking on stairs (57%).

    Conclusion: Overall this study demonstrates that participants were quite satisfied with their assistive device and the service received by the P&O clinic. No statistically significant differences regarding satisfaction with assistive device and service, or mobility, were found between prosthetic and orthotic participants.

  • 2224. Westerling, R
    et al.
    Hanning, M
    Eckerlund, I
    Rosén, M
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Åtgärdbara dödsorsaker en indikator på hälso- och sjukvårdens resultat och kvalitet1994Report (Other academic)
  • 2225. Westerling, Ragnar
    et al.
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    The European Community 'avoidable death indicators' in Sweden 1974-19851992In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 21, no 3, p. 502-10Article in journal (Refereed)
    Abstract [en]

    Avoidable mortality in Sweden 1974-1985 was analysed using a European Community (EC) Working Group list of 'avoidable death indicators." The list includes causes of death that in certain age groups were defined as indicators of the outcome of medical care intervention or for some conditions, indicators of the national health policies. About 10 out of 14 medical health care indicators occurred in less than 50 cases per year. Death rates decreased over the 12-year period studied for most avoidable death indicators. For women, however, the death rate for malignant neoplasms of the trachea, bronchus and lung increased significantly. Swedish total mortality for ages 5-64 years was lower than the EC standards 1974-1978 and 1980-1984. Most of the avoidable causes of death had a relatively low standard mortality rate (SMR) when compared to both the EC standard and to the Swedish SMR for total mortality. For asthma, however, the Swedish SMR was higher. The development and implementation of the avoidable death concept and methodology is discussed.

  • 2226.
    Westerling, Ragnar
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Westin, Marcus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    McKee, Martin
    Hoffmann, Rasmus
    Plug, Iris
    Rey, Gregoire
    Jougla, Eric
    Lang, Katrin
    Paerna, Kersti
    Alfonso, Jose L.
    Mackenbach, Johan P.
    The timing of introduction of pharmaceutical innovations in seven European countries2014In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 20, no 4, p. 301-310Article in journal (Refereed)
    Abstract [en]

    Rationale, aims and objectives Differences in the performance of medical care may be due to variation in the introduction and diffusion of medical innovations. The objective of this paper is to compare seven European countries (United Kingdom, the Netherlands, West Germany, France, Spain, Estonia and Sweden) with regard to the year of introduction of six specific pharmaceutical innovations (antiretroviral drugs, cimetidine, tamoxifen, cisplatin, oxalaplatin and cyclosporin) that may have had important population health impacts. Methods We collected information on introduction and further diffusion of drugs using searches in the national and international literature, and questionnaires to national informants. We combined various sources of information, both official years of registration and other indicators of introduction (clinical trials, guidelines, evaluation reports, sales statistics). Results and conclusions The total length of the period between first and last introduction varied between 8 years for antiretroviral drugs and 22 years for cisplatin. Introduction in Estonia was generally delayed until the 1990s. The average time lags were smallest in France (2.2 years), United Kingdom (2.8 years) and the Netherlands (3.5 years). Similar rank orders were seen for year of registration suggesting that introduction lags are not only explained by differences in the process of registration. We discuss possible reasons for these between-country differences and implications for the evaluation of medical care.

  • 2227.
    Westerlund, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Garvare, Rickard
    Department of Business Administration, Luleå University of Technology, Luleå, Sweden.
    Höög, Elisabet
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Department of Learning, Information, Management and Ethics, Karolinska Institutet, Stockholm.
    Nyström, Monica
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Department of Learning, Information, Management and Ethics, Karolinska Institutet, Stockholm.
    Facilitating system-wide organizational change in health care2015In: International Journal of Quality and Service Sciences, ISSN 1756-669X, E-ISSN 1756-6703, Vol. 7, no 1, p. 72-89Article in journal (Refereed)
    Abstract [en]

    Purpose: The purpose of this paper was to investigate the role of an intra-organizational change facilitating function (CFF) in relation to a multi-level development initiative in a health care organization. Involved actors’ views on factors in need of attention and how the CFF related to these factors were studied.

    Design/methodology/approach: A longitudinal case study design was used, combining data from questionnaires, process diaries and interviews with employees at the CFF, managers and clinic staff.

    Findings: Factors on micro, meso and macro levels, crucial to attend to, were highlighted by respondents at staff and managerial levels. The CFF related to some of these factors by acting upon them, or by developing plans to handle them, while other factors were unattended to. The CFF activities also had indirect influence on other factors. The CFF role and responsibilities were not clearly defined beforehand, and a need to clarify a division of roles and responsibilities is highlighted.

    Research limitations/implications: Our study contributes to current knowledge on facilitation of change by relating it to an organizational dimension of implementation.

    Practical implications: The description of important factors to handle during a large organizational change process and issues a CFF can encounter may aid others involved in designing and managing large organizational development initiatives.

    Originality/value:The study elaborates on less studied functions and roles of an intra-organizational CFF in relation to factors of vital importance for organizational change and development in health-care organizations.

  • 2228.
    Westerlund, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Garvare, Rickard
    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, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Eurenius, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Lindkvist, Marie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Managing the initiation and early implementation of health promotion interventions: a study of a parental support programme in primary care2017In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 31, no 1, p. 128-138Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Mental health problems are increasing among children and adolescents worldwide, and parental support programmes have been suggested as one preventive intervention. However, the actual impact and low rates of adoption and sustainability of prevention programmes have proven to be a concern, and thus, further studies on their implementation are needed.

    AIM: This study focused on the initial implementation of the International Child Development Programme (ICDP) in primary care. The aim was to investigate the involved actors' views on factors likely to affect implementation and the strategies used to manage them.

    DESIGN: A case study design with a mixed-methods approach combining quantitative and qualitative data from questionnaires and interviews was used.

    METHODS: Eighty-two professionals at different positions in the involved organisations participated. Directed content analysis was used for analyses, focusing on perceived levels of importance and the manifestation of implementation factors.

    FINDINGS: Interviews and questionnaires provided descriptions of factors influencing the initial ICDP implementation. Uncertainty on how to manage important factors and vague change strategies was reported. Discrepancies in the perceived levels of importance versus manifestation were found regarding several factors, including hands-on support, time and resources, communication and information, a comprehensive plan of action, follow-ups, and external and internal collaborations. Manifested factors were a need for change, motivation and the ICDP's compatibility with existing norms, values and practices.

    CONCLUSIONS: Implementing a parental support programme in a complex setting will benefit from being preceded by a thorough examination of the intervention and the target context and the development of clear implementation strategies based on the results of that examination. This study provides insights into how and by whom knowledge on implementation is applied during the launch of a health promotion programme, and these insights might help increase the rate of adoption and the use of such programmes and thereby increase their effectiveness.

  • 2229.
    Westman, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Social medicine.
    Planning primary health care provision: assessment of development work at a health centre1986Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    At the Primary Health Care Centre in Vännäs (VPHCC), northern Sweden, a development work was implemented in 1976-1980. The overall purpose was to enhance primary health care planning. In trying to improve health care delivery cooperation with community members was initiated and some organizational changes like a new appointment system, a new medical record and local care programs for some common diseases were introduced. Official statistics were also used for comparative purposes.

    The aims of the work were postulated (increased accessibility, higher continuity, more equitable distribution and enhanced cooperation) and suitable methods were designed. From postal surveys, chartreviews and administrative data (from hospitals, out-patient clinics and health centres) figures and information were collected.

    Accessibility was studied by waiting room time which was reduced and continuity, analyzed with a new concept - visit based provider continuity - was improved. The question of equitable distribution was studied by the consultation rates at different out-patient clinics. It seemed as if the local development work changed the patterns of utilization but some important issues were not decisively answered.

    Repeated postal surveys reflected the question of equitable distribution and the cooperation between the VPHCC and the community members. Positive responses were recorded in aspects like telephone accessibility and health care information. In a tracer study of diabetes the quality of care was studied. The local care program was actually implemented in the daily practice but the question of care quality needs further penetration.

    Within the frames of the development work new methods in the health care planning were introduced. Our work started from the prerequisits of the VPHCC and other health centres might find other ways of planning for care provision. On a general level, however, the structure of our work - defining aims, means and evaluation methods - can be used by others.

  • 2230. Westrin, C G
    et al.
    Nilstun, T
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Haglund, B
    Epidemiology and moral philosophy1992In: Journal of Medical Ethics, ISSN 0306-6800, E-ISSN 1473-4257, Vol. 18, no 4, p. 193-96Article in journal (Refereed)
    Abstract [en]

    To an increasing extent ethical controversies affect and sometimes obstruct public health work and epidemiological research. In order to improve communication between the concerned parties a model for identification and analysis of ethical conflicts in individual-based research has been worked out in co-operation between epidemiologists and moral philosophers. The model has two dimensions. One dimension specifies relevant ethical principles (as beneficence, non-maleficence, autonomy and justice). The other dimension specifies the groups of persons involved in the conflict under consideration (for example: the study-population, individuals who may benefit from the results, the researchers and their personnel, the community at large). The model has been applied to the problem of legitimacy of case-register research and to problems in psychiatric health services research as well as epidemiological research.

  • 2231. Wettergren, Lena
    et al.
    Lindberg, Mathilde Hedlund
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Kettis, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Glimelius, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Oncology.
    Ring, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Comparison of two instruments for measurement of quality of life in clinical practice - a qualitative study2014In: BMC Medical Research Methodology, ISSN 1471-2288, E-ISSN 1471-2288, Vol. 14, p. 115-Article in journal (Refereed)
    Abstract [en]

    Background: The study aimed to investigate the meaning patients assign to two measures of quality of life: the Schedule for Evaluation of Individual Quality of Life Direct Weighting (SEIQoL-DW) and the SEIQoL-DW Disease Related (DR) version, in a clinical oncology setting. Even though the use of quality of life assessments has increased during the past decades, uncertainty regarding how to choose the most suitable measure remains. SEIQoL-DW versions assesses the individual's perception of his or her present quality of life by allowing the individual to nominate the domains to be evaluated followed by a weighting procedure resulting in qualitative (domains) as well as quantitative outcomes (index score). Methods: The study applied a cross-sectional design with a qualitative approach and collected data from a purposeful sample of 40 patients with gastrointestinal cancer. Patients were asked to complete two measures, SEIQoL-DW and the SEIQoL-DR, to assess quality of life. This included nomination of the areas in life considered most important and rating of these areas; after completion patients participated in cognitive interviews around their selections of areas. Interviews were audiotaped and transcribed verbatim which was followed by analysis using a phenomenographic approach. Results: The analyses of nominated areas of the two measures resulted in 11 domains reflecting what patients perceived had greatest impact on their quality of life. Analysis of the cognitive interviews resulted in 16 thematic categories explaining the nominated domains. How patients reflected around their quality of life appeared to differ by version (DW vs. DR). The DW version more often related to positive aspects in life while the DR version more often related to negative changes in life due to having cancer. Conclusions: The two SEIQoL versions tap into different concepts; health-related quality of life, addressing losses and problems related to having cancer and, quality of life, more associated with aspects perceived as positive in life. The SEIQoL-DR and the SEIQoL-DW are recommended in clinical practice to take both negative and positive aspects into account and acting on the problems of greatest importance to the patient.

  • 2232.
    Wiberg, Michael
    et al.
    Department of Clinical Neuroscience, Karolinska Institutet.
    Friberg, Emilie
    Department of Clinical Neuroscience, Karolinska Institutet.
    Stenbeck, Magnus
    Department of Clinical Neuroscience, Karolinska Institutet.
    Alexanderson, Kristina
    Department of Clinical Neuroscience, Karolinska Institutet.
    Norlund, Anders
    Department of Clinical Neuroscience, Karolinska Institutet.
    Hillert, Jan
    Department of Clinical Neuroscience, Karolinska Institutet.
    Tinghög, Petter
    Department of Clinical Neuroscience, Karolinska Institutet.
    Sources and level of income among individuals with multiple sclerosis compared to the general population: A nationwide population-based study.2015In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 21, no 13, p. 1730-1741Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Multiple sclerosis (MS) is associated with reduced work capacity, but there is limited knowledge about MS patients' sources of income.

    OBJECTIVES: The purpose of this study was to elucidate MS patients' earnings and social benefits compared to those of the general population.

    METHODS: From nationwide registers of all residents in Sweden aged 21-64 years in 2010 (n=5,291,764), those with an MS diagnosis (n=13,979) were compared to a propensity score matched reference group (n=69,895). Descriptive statistics and regression models were used to estimate the percentage difference between the MS patients and the matched references regarding the following annual incomes: earnings, disability pension, sickness absence, disability allowance, unemployment compensation and social assistance.

    RESULTS: Both MS patients and the matched references received most of their income from earnings followed by disability pension and sickness absence. MS patients that were diagnosed in 2010 had 15% lower earnings than the matched references, while MS patients diagnosed before 2005 had 38% lower earnings. Corresponding figures regarding summed social benefits were 33% and 130% higher for MS patients, respectively.

    CONCLUSION: The results indicate that MS patients are overrepresented, in relative and absolute terms, regarding health-related benefits and have lower levels of earnings. However, the redistributing welfare systems appear to financially compensate the MS patients considerably.

  • 2233. Widmark, Catharina
    et al.
    Sandahl, Christer
    Piuva, Katarina
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Bergman, David
    Do views on psychosocial needs of children and adolescents differ among professionals depending on their organisational affiliation? A qualitative study2016In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 30, no 5, p. 643-648Article in journal (Refereed)
    Abstract [en]

    Unit managers and employees in schools, social services, and child and adolescent mental health services (CAMHS) were asked to describe their views on children's and adolescents' psychosocial needs when collaboration was required. A descriptive case study design was employed and data were gathered from 23 professionals in six focus groups. The data were analysed by the use of an inductive content approach. Disparities were identified that were interpreted as different approaches to children's needs, which we designated individual (CAMHS), contextual (social services), and educational (schools) approaches. These were perceived as emerging from the professional representations of children's needs that were created within each working group. The organisational affiliation seemed however to have a stronger influence than professional education, regarding the view of children's needs. We suggest that it would be an advantage for professionals to be able to participate in dialogue groups to discuss the meaning of their organisational and professional affiliations, and how this affects their views. Rather than formal knowledge, such dialogues should contain more essential knowledge related to the professionals' approaches to children's needs and to the diversities in the way they think and work in a give-and-take process. This might influence their way of thinking and working with children and adolescents, and strengthen their understanding of each other's work.

  • 2234.
    Wihlman, Ulla
    et al.
    Karolinska Institutet, Stockholm, Sweden .
    Stålsby-Lundborg, Cecilia
    Karolinska Institutet, Stockholm, Sweden .
    Holmström, Inger
    Uppsala University, Uppsala, Sweden.
    Axelsson, Runo
    Nordic School of Public Health, Göteborg, Sweden.
    Organising vocational rehabilitation through interorganisational integration – a case study in Sweden2011In: International Journal of Health Planning and Management, ISSN 0749-6753, E-ISSN 1099-1751, Vol. 26, no 3, p. 169-183Article in journal (Refereed)
    Abstract [en]

    This study describes and analysis five years of experiences from organising an interorganisational project on vocational rehabilitation. A qualitative case study approach was used based on interviews, focus group discussions and documents. The aim was to analyse how and why the project was organised in the way it was in relation to theories of integration, organisational change and learning. The results show that the vocational rehabilitation project was initiated mainly for financial reasons. It was organised as a mechanistic system with the aim of producing different activities, where financial control and support from all the levels of the organisations involved was important. A new bureaucracy between the different authorities involved was built up, where the vertical (top-down) integration was more important than the horizontal. The result was scattered islands of interprofessional work in different teams, but without contacts between them. The project did not influence the processes or workflows of the organisations involved in the project, which would be important from a service-user perspective. It may therefore be questionnable to organise the development of interorganisational integration for vocational rehabilitation in a separate project organisation. Instead, interorganisational networks with focus on interconnections of processes and workflows may be more flexible and adaptable.

  • 2235.
    Wihlman, Ulla
    et al.
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Stålsby-Lundborg, Cecilia
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Holmström, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Axelsson, Runo
    Nordic School of Public Health, Göteborg, Sweden.
    Organising vocational rehabilitation through interorganisational integration: a case study in Sweden2011In: International Journal of Health Planning and Management, ISSN 0749-6753, E-ISSN 1099-1751, Vol. 26, no 3, p. e169-e185Article in journal (Refereed)
    Abstract [en]

    This study describes and analysis five years of experiences from organising an interorganisational project on vocational rehabilitation. A qualitative case study approach was used based on interviews, focus group discussions and documents. The aim was to analyse how and why the project was organised in the way it was in relation to theories of integration, organisational change and learning. The results show that the vocational rehabilitation project was initiated mainly for financial reasons. It was organised as a mechanistic system with the aim of producing different activities, where financial control and support from all the levels of the organisations involved was important. A new bureaucracy between the different authorities involved was built up, where the vertical (top-down) integration was more important than the horizontal. The result was scattered islands of interprofessional work in different teams, but without contacts between them. The project did not influence the processes or workflows of the organisations involved in the project, which would be important from a service-user perspective. It may therefore be questionnable to organise the development of interorganisational integration for vocational rehabilitation in a separate project organisation. Instead, interorganisational networks with focus on interconnections of processes and workflows may be more flexible and adaptable.

  • 2236.
    Wiig, Siri
    et al.
    Department of Health Studies, University of Stavanger, N-4036 Stavanger, Norway.
    Aase, Karina
    Department of Health Studies, University of Stavanger, N-4036 Stavanger, Norway.
    von Plessen, Christian
    Department of Health Studies, University of Stavanger, N-4036 Stavanger, Norway.
    Burnett, Susan
    Imperial College, London, St Mary’s Campus, Norfolk Place, London W2 1PG, UK.
    Nunes, Francisco
    ISCTE, Lisboa, Instituto Superior de Ciências do Trabalho e da Empresa (ISCTE), Av.ª das Forças Armadas, Lisbon 1649-026, Portugal.
    Weggelaar, Anne Marie
    Department of Health Policy and Management, Erasmus University Rotterdam, Postbus 1738, 3000 DR Rotterdam, The Netherlands.
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Calltorp, Johan
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Fulop, Naomi
    Department of Applied Health Research, University College London, 1-19 Torrington Place, London WC1E 7HB, UK.
    Talking about quality: exploring how ‘quality’ is conceptualized in European hospitals and healthcare systems2014In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 14, no 478, p. 1-12Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Conceptualization of quality of care - in terms of what individuals, groups and organizations include in their meaning of quality, is an unexplored research area. It is important to understand how quality is conceptualised as a means to successfully implement improvement efforts and bridge potential disconnect in language about quality between system levels, professions, and clinical services. The aim is therefore to explore and compare conceptualization of quality among national bodies (macro level), senior hospital managers (meso level), and professional groups within clinical micro systems (micro level) in a cross-national study.

    METHODS:

    This cross-national multi-level case study combines analysis of national policy documents and regulations at the macro level with semi-structured interviews (383) and non-participant observation (803 hours) of key meetings and shadowing of staff at the meso and micro levels in ten purposively sampled European hospitals (England, the Netherlands, Portugal, Sweden, and Norway). Fieldwork at the meso and micro levels was undertaken over a 12-month period (2011-2012) and different types of micro systems were included (maternity, oncology, orthopaedics, elderly care, intensive care, and geriatrics).

    RESULTS:

    The three quality dimensions clinical effectiveness, patient safety, and patient experience were incorporated in macro level policies in all countries. Senior hospital managers adopted a similar conceptualization, but also included efficiency and costs in their conceptualization of quality. 'Quality' in the forms of measuring indicators and performance management were dominant among senior hospital managers (with clinical and non-clinical background). The differential emphasis on the three quality dimensions was strongly linked to professional roles, personal ideas, and beliefs at the micro level. Clinical effectiveness was dominant among physicians (evidence-based approach), while patient experience was dominant among nurses (patient-centered care, enough time to talk with patients). Conceptualization varied between micro systems depending on the type of services provided.

    CONCLUSION:

    The quality conceptualization differed across system levels (macro-meso-micro), among professional groups (nurses, doctors, managers), and between the studied micro systems in our ten sampled European hospitals. This entails a managerial alignment challenge translating macro level quality definitions into different local contexts.

  • 2237. Wiitavaara, Birgitta
    et al.
    Fahlström, Martin
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Professionell Development.
    Djupsjöbacka, Mats
    Prevalence, diagnostics and management of musculoskeletal disorders in primary health care in Sweden: an investigation of 2000 randomly selected patient records2017In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 23, no 2, p. 325-332Article in journal (Refereed)
    Abstract [en]

    RATIONALE, AIMS AND OBJECTIVES: The aims of this study is to investigate the prevalence of patients seeking care due to different musculoskeletal disorders (MSDs) at primary health care centres (PHCs), to chart different factors such as symptoms, diagnosis and actions prescribed for patients that visited the PHCs due to MSD and to make comparisons regarding differences due to gender, age and rural or urban PHC.

    METHODS: Patient records (2000) for patients in working age were randomly selected equally distributed on one rural and one urban PHC. A 3-year period was reviewed retrospectively. For all patient records' background data, cause to the visit and diagnosis were registered. For visits due to MSD, type and location of symptoms and actions to resolve the patients problems were registered. Data was analysed using cross tabulation, multidimensional chi-squared.

    RESULTS: The prevalence of MSD was high; almost 60% of all patients were seeking care due to MSD. Upper and lower limb problems were most common. Symptoms were most prevalent in the young and middle age groups. The patients got a variety of different diagnoses, and between 13 and 35% of the patients did not receive a MSD diagnose despite having MSD symptoms. There was a great variation in how the cases were handled.

    CONCLUSIONS: The present study points out some weaknesses regarding diagnostics and management of MSD in primary care.

  • 2238. Wijk, H
    et al.
    Öhlen, J
    Lidén, E
    German Millberg, L
    Jacobsson, C
    Söderberg, S
    Berg, L
    Engström, Å
    Höglund, I
    Lepp, Margret
    Lindström, I
    Nygren, B
    Person, C
    Petzäll, K
    Skär, L
    Suserud, Björn-Ove
    University of Borås, School of Health Science.
    Söderlund, M
    Verksamhetsförlagd utbildning på avancerad nivå: ny utmaning för specialistutbildningar för sjuksköterskor2009In: Vård i Norden, ISSN 0107-4083, E-ISSN 1890-4238, Vol. 29, no 4, p. 41-43Article in journal (Other academic)
    Abstract [en]

    The aim of this article is to discuss challenges in the development of Specialist Nursing Educations as a result of the 2007 Swedish Higher Education Reform: the implementation of the so-called Bologna process. Certain challenges follow this reform, particularly since the specialist nursing programmes will be part of the second cycle of the higher education system, and it will be possible to combine the professional degree with a masters degree (one year). Possible strategies in four areas related to the Specialist Nursing Education are discussed: integration of researchbased knowledge, experienced-based knowledge, improvement knowledge, and strategies for collaboration between university institutions and clinics. Specific didactical issues are raised.

  • 2239.
    Wikander, Robert
    et al.
    Halmstad University, School of Business and Engineering (SET), Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine.
    Augustsson, Johan
    Halmstad University, School of Business and Engineering (SET), Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine.
    Kan ett nyutvecklat handledsstöd förbättra möjligheterna för funktionell träning av övre extremiteten för reumatiker?: En SEMG-studie2011Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    In a general rehabilitation phase weight training is an important part because of muscle weakness may contribute lower functional ability and could lead to decreasing movement patterns. Limited range of motion (ROM) in the upper extremity is a contributing factor to individuals unable to perform everyday activities. Several studies have documented that patients with rheumatoid arthritis (RA) have impaired hand function due to reduced grip strength and limitations in ROM. Functional training is designed to strengthen the weak muscles that cause imbalance or pain while your body becomes more mobile. Using everyday movements and implement them with training will make the training more functional. The purpose of this study was to develop and evaluate a new wrist support that increases the possibilities to functional training of upper extremities for rheumatoid arthritis patients.

    The study involved 27 women, 8 were diagnosed with RA and 19 healthy subjects. The average age was 38 year (20-73year). Muscle activity in m. trapezius and m. rhomboideus was measured using surface electromyography (sEMG) in three exercises to compare the differences between both RA and healthy, and with and without a developed product.

    The results showed that it was possible to perform functional training of upper extremities without using the hand grip strength. There were no significant differences in muscle activity in m. trapezius and m. rhomboideii with or without the product. The results also showed that rheumatic muscles are not different from healthy muscles. The participants' subjective opinions were very positive there 24 of 27 participants found it easier to carry out the exercise

    with the product and 9 of 27 felt it was easier to focus on exercise.

    The study resulted in a new wrist support that allows functional training of m.trapezius and m.rhomboideus for patients with rheumatoid arthritis.

  • 2240. Wikberg, Anita
    et al.
    Bondas, Terese
    University of Borås, School of Health Science.
    A patient perspective in research on intercultural caring in maternity care: A meta-ethnography2010In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 5, no 1, p. 1-15Article in journal (Refereed)
    Abstract [en]

    Abstract The aim of this study is to explore and describe a patient perspective in research on intercultural caring in maternity care. In total, 40 studies are synthesized using Noblit and Hare’s meta-ethnography method. The following opposite metaphors were found: caring versus non-caring; language and communication problems versus information and choice; access to medical and technological care versus incompetence; acculturation: preserving the original culture versus adapting to a new culture; professional caring relationship versus family and community involvement; caring is important for well-being and health versus conflicts cause interrupted care; vulnerable women with painful memories versus racism. Alice in Wonderland emerged as an overarching metaphor to describe intercultural caring in maternity care. Furthermore, intercultural caring is seen in different dimensions of uniqueness, context, culture, and universality. There are specific cultural and maternity care features in intercultural caring. There is an inner core of caring consisting of respect, presence, and listening as well as external factors such as economy and organization that impact on intercultural caring. Moreover, legal status of the patient, as well as power relationships and racism, influences intercultural caring. Further meta-syntheses about well-documented intercultural phenomena and ethnic groups, as well as empirical studies about current phenomena, are suggested.

  • 2241. Wikberg, Anita
    et al.
    Erikson, Katie
    Bondas, Terese
    University of Borås, School of Health Science.
    Intercultural caring in maternity care from a patient perspective: a metaethnography2009Conference paper (Refereed)
  • 2242. Wiklund, S
    et al.
    Norelius, M
    Perk, Joep
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Check-up your hearthealth at the pharmacy2012In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 19, no 1, p. S82-Article in journal (Refereed)
  • 2243.
    Wikström, Eva
    Växjö University, Faculty of Humanities and Social Sciences, School of Social Sciences.
    Inflytandets paradoxer: Möjligheter och hinder för självbestämmande och inflytande i hemtjänsten2005Licentiate thesis, monograph (Other academic)
    Abstract [sv]

    Betydelsen av självbestämmande och inflytande i hemtjänsten ses som efter-strävansvärt i både forskning, lagstiftning och i aktuella offentliga dokument, men flera studier visar att det finns ett gap mellan de politiska intentionerna och praxis. Hur självbestämmande och brukarinflytande ska förstås och omsättas i praktiken är inte närmare specificerat av lagstiftaren, vilket skapar tolkningsut-rymme. Den positiva laddning som begreppen har hör därmed samman med att de tas för givna som eftersträvansvärda, utan att konsekvenser av olika tolk-ningsmöjligheter problematiseras. Syftet med avhandlingen var att öka förstå-elsen för de möjligheter och hinder som finns för hjälptagarens inflytande i hem-tjänstens vardag genom att studera den påverkan som olika idealtypiska perspek-tiv har. Som analysinstrument utvecklades tre idealtypiska perspektiv: det soci-ala, det medicinska och det marknadsekonomiska, som har sina egna bakomlig-gande logiker, och som finns som styrande perspektiv i hemtjänsten genom att påverka tolkningar och handlingar.

    Det empiriska materialet utgjordes av intervjuer med hjälptagare, vårdbiträden och ledningspersoner i fyra arbetsgrupper från olika kommuner. I resultatet visa-des att de fyra arbetsplatserna var organiserade på olika sätt och att de hade egna sociala regelsystem med kännetecken från de tre perspektiven i olika hög grad. De sociala regelsystemen var styrande över vad vårdbiträdena förväntades och kunde göra i vardagsarbetet, vilket i sin tur innebar att begreppet brukarinflytan-de fick olika innebörd. Över hälften av hjälptagarna i studien var 80 år eller äldre och det visade sig att de ville ha inflytande över de egna hjälpinsatserna, samti-digt som de upplevde att det fanns brister. Viljan till inflytande handlade främst om att bevara kontrollen över vardagen trots behov av hjälp. De största problem-områdena var att vårdbiträdena var så jäktade att de inte hann framföra sina öns-kemål, att de kommunala riktlinjerna begränsade deras möjlighet att få önskad hjälp, att man befann sig i en beroendesituation samt att de som hjälptagare sak-nade grundläggande kunskap om de beslutade insatsernas innehåll och omfång.

    Avhandlingen har fått namnet Inflytandets paradoxer, vilket står för de mot-sägelsefulla fenomen som vårdbiträdet är ställd inför i vardagen, i bemötandet av hjälptagarens strävan efter inflytande och självbestämmande. Paradoxerna är motsägelsefulla till sin natur genom att det inte finns en självklar handlingsstra-tegi för hur inflytande och självbestämmande ska bemötas. De fyra paradoxer som identifierades berör liknande områden som hjälptagarna upplevde som kri-tiska. Det var tiden där motsättningen låg mellan processtid och lineär tid, det var biståndsbeslutet som ramverk där motsättningen fanns mellan detaljerade beslut och rambeslut, det var balanseringen mellan beroende och ansvar, där motsätt-ningen handlade om vilket ansvar som gavs hjälptagaren, samt, kunskap och tolkningsföreträde, där motsättningen fanns mellan vem som hade mest legitim kunskap i olika situationer. För att förstå varför vårdbiträdena hanterade motsätt-ningarna som de gjorde analyserades dessa i relation till arbetsplatsernas sociala regelsystem, vilka i sin tur var färgade av de tre idealtypiska perspektiven.

  • 2244.
    Wikström, Ewa
    et al.
    Göteborgs Universitet.
    Arman, Rabecka
    Göteborgs Universitet.
    Dellve, Lotta
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Vad gör chefer med sin tid och hur kan tid och engagemang hanteras på ett mer hållbart sätt?2013In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 90, no 6Article in journal (Refereed)
    Abstract [sv]

    En studie om chefers tidsanvändning har genomförts med syftet att undersöka hur man kan understödja mer hållbar tidsanvändning och hållbart engagemang. Chefer hade många korta aktiviteter och många möten men kommunicerade sällan med sin egen chef på tu man hand. Arbetet präglades av ständiga förhandlingar, prioriteringar och omprioriteringar. Om chefer inte har enskild tid för att kommunicera med sin överordnade får det konsekvenser avseende att kunna göra välavvägda och acceptabla prioriteringar och i förlängningen för legitimiteten i ledarskapet. Vården och dess chefer har mycket att vinna på att utveckla kommunikationen om vardagsarbetetes dilemman. Utifrån våra resultat har ett studiematerial utvecklats som syftar till att stödja chefer och ledningsgrupper i det vardagliga arbetet avseende hållbart ledarskap, chefskap och tidsanvändning.

  • 2245. Wikström, Ewa
    et al.
    Arman, Rebecka
    Dellve, Lotta
    University of Borås, School of Health Science.
    Vad gör chefer med sin tid och hur kan tid och engagemang hanteras på2013In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. Tema Ledarskap, no 6, p. 830-837Article in journal (Refereed)
    Abstract [sv]

    En studie om chefers tidsanvändning har genomförts med syftet att undersöka hur man kan understödja mer hållbar tidsanvändning och hållbart engagemang. Chefer hade många korta aktiviteter och många möten men kommunicerade sällan med sin egen chef på tu man hand. Arbetet präglades av ständiga förhandlingar, prioriteringar och omprioriteringar. Om chefer inte har enskild tid för att kommunicera med sin överordnade får det konsekvenser avseende att kunna göra välavvägda och acceptabla prioriteringar och i förlängningen för legitimiteten i ledarskapet. Vården och dess chefer har mycket att vinna på att utveckla kommunikationen om vardagsarbetetes dilemman. Utifrån våra resultat har ett studiematerial utvecklats som syftar till att stödja chefer och ledningsgrupper i det vardagliga arbetet avseende hållbart ledarskap, chefskap och tidsanvändning

  • 2246.
    Wikström, Ewa
    et al.
    Sahlgrenska akademin, Göteborgs universitet.
    Dellve, Lotta
    Sahlgrenska akademin, Göteborgs universitet.
    Contemporary Leadership in Healthcare Organizations: Fragmented or Concurrent Leadership and Desired Support2009In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 23, no 4, p. 411-428Article in journal (Refereed)
  • 2247. Wilde Björling, Camilla
    et al.
    Lagerlund, Magnus
    Östlund, Martin
    Linnaeus University, Faculty of Science and Engineering, School of Computer Science, Physics and Mathematics.
    Johansson, Pauline
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Axelsson, Clara
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Johnsson, Stefan
    Can patients be better prepared and more satisfied during the course of radiation therapy by using iPad's?2012In: Radiotherapy and Oncology: Vol. 103 Supplement 1, 2012, p. S30-Conference paper (Refereed)
  • 2248.
    Williamsson, Anna
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Ergonomics.
    Change agents and use of visual management tools in care process redesign: Implications on working conditions for operative managers and healthcare professionals2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Swedish healthcare has been subject to change efforts to increase efficiency in care processes. In the 2000-2010’s lean production has influenced healthcare with change approaches such as visual management tools to increase patient flows and efficiency. Most previous research on lean healthcare has focused single hospitals or departments as case studies focusing lean production as successful for efficiency, or “mean” production affecting the work environment. Focus in this thesis though is instead on what strategies and approaches hospitals use in their care process redesign and their associations with working conditions and systems performance. This thesis’ overall aim was to assess change strategies and change approaches at strategic and operative levels during care process redesign at hospitals, focusing organization of change agents and use of visual management tools, and its implica-tions for alignment, working conditions and systems performance. Four studies were conducted at five Swedish hospitals, whereof three had lean-inspired change strategies. One qualitative cross-sectional study, one quantitative longitudinal study and two mixed method longitudinal studies are included in the thesis. Data was collected over three years with semi-structured interviews, structured interviews, staff questionnaires, manager questionnaires and photo document-ation. Qualitative data were analyzed by content analysis. Quantitative data were analyzed with Wilcoxon tests, mixed models of repeated measurements, ANOVA, and linear regression models. Results showed strategies involve operative manag-ers as change drivers, supported by change agent functions. Change agents’ contribution to change depends on e.g. closeness to operative managers due to the change agents place in the healthcare hierarchy, and also clarity regarding roles and responsibilities in change. Change agents with a close collaboration with operative managers, have better preconditions to contribute to alignment between change strategies and change approaches. Hospital care units in the 2010’s tend to use lean-inspired operative change approaches also without working with change strategies based on lean. Operative lean approaches show associations with positive working conditions for healthcare professionals. Visual management tools as change strategy has potential to support collaboration and communication within and between organizational levels and is considered to contribute to systems performance and alignment. Visual management tools as a cognitive job resource for operative managers show associations with e.g. lower burnout and more functioning collaboration as well as daily use among nurses show associations with cognitive, social and emotional benefits, perceived systems performance and buffering mental stress. Change agents and use of visual management tools are considered as contributors for operative managers’ and healthcare professionals’ sustainable work during care process redesign.

  • 2249.
    Williamsson, Anna
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Ergonomics.
    Operative managers' job-demands-resources when redesigning care processesManuscript (preprint) (Other academic)
    Abstract [en]

    Purpose

    The aim was to describe hospitals’ approaches to use change agents and visualmanagement tools, and examine change agents and visual management tools as job resourcesfor operative managers, during care process redesign.

    Design

    A longitudinal three year (T0, T1, T2) mixed method design was used. Qualitativedata from semi-structured interviews was collected at five hospitals (T0, T2). Quantitativedata from questionnaires (T1, T2) was collected to examine the use and support from changeagents and visual management tools among operative managers at the hospitals. Operativemanagers’ support and associations with their working conditions were further examined inrelation to the Job Demands and Resources model. Analyses of differences between groups ofoperative managers were performed with Wilcoxon tests.

    Findings

    Change agents as emotional job resources supported operative managers whenintroducing care process redesign. Higher change agent support was associated to positiveresults regarding burnout and organizational outcomes. Visual management tools as cognitivejob resources supported operative managers when used daily, and were associated to positiveresults regarding burnout, and organizational outcomes. Combined support from both changeagents and visual management tools was associated to beneficial organizational outcomes(collaboration between operative managers as well as between operative managers andhealthcare professionals during care process redesign, and possibilities to fulfill managerialduties) and thus were considered as important job resources for operative managers to drivechange.

  • 2250.
    Williamsson, Anna
    et al.
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Ergonomics.
    Dellve, Lotta
    Karltun, Anette
    Nurses’ use of visual management in hospitals - a longitudinal, quantitative study on its implications on systems performance and working conditions2018In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to examine potential benefits provided by dailyvisual management tool use and explore its association with systems performanceand working conditions among hospital nurses.Background: Visual management tools used in everyday work and improvementwork in health care theoretically contribute to shared understanding of complexwork systems and provide certain user benefits. Cognitive load, miscommunicationwithin and between professional groups, and pressure to engage in care processredesign add to nurses’ strained working conditions.Design: Quantitative longitudinal.Methods: Questionnaires were distributed at T0, (N = 948, 66% response rate), T1(N = 900, 70% response rate), and T2 (N = 621, 72% response rate) to nurses atfive hospitals. Three groups of users (daily users, start users, and non‐daily users)were compared by means T1–T2 (significance tested with Wilcoxon signed ranktest) and by mixed model repeated measures T0, T1, T2.Results: Daily use associated to better overview of work, collaboration, social capital,and clinical engagement. Job resources were rated higher by daily users. Mentalstress increased and development opportunities decreased over time among nondailyusers. There were associations between use and perceptions of systems performance,though the differences between groups were small.Conclusion: This study specifically explores visual management tool use in the hospitalsetting, which contributes to research by broadening the understanding of cognitive,social, and emotional benefits provided by visual management tool use. Dailyuse was associated to positive working conditions, small but positive differences insystems performance, and indicated a buffering effect on nurses’ mental stress.

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