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Biography [eng]

Ulrika Winblad, Ph.D., is an associate professor, senior lecturer, and director of postgraduate studies in the Department of Public Health and Caring Sciences at Uppsala University. Winblad’s research interests include the marketization of health care, quality and performance in health and elder care organizations; and the implementation of health policy.  Winblad received her Ph.D. in health services research from Uppsala University. 

Publications (10 of 157) Show all publications
Blomqvist, P. & Winblad, U. (2024). Have the Welfare Professions Lost Autonomy?: A Comparative Study of Doctors and Teachers. Journal of Social Policy, 53(1), 64-85
Open this publication in new window or tab >>Have the Welfare Professions Lost Autonomy?: A Comparative Study of Doctors and Teachers
2024 (English)In: Journal of Social Policy, ISSN 0047-2794, E-ISSN 1469-7823, Vol. 53, no 1, p. 64-85Article in journal (Refereed) Published
Abstract [en]

This article investigates the impact of NPM reforms on two prominent welfare state professions; medical doctors and teachers. The case study context is Sweden, where the impact of NPM led to a series of reforms in health care and education after 1990. The focus in the paper is on professional autonomy, which can be seen as a core trait in professional work. The findings in the article point to both medical doctors and teachers having lost professional autonomy as a result of NPM-reforms, particularly with regards to the dimensions of work organization and evaluation. Autonomy in individual decision-making seems to have been least affected, even if there are indications of this being infringed upon as well. Despite these broad similarities, the loss of autonomy is found to be more pronounced in the case of teachers. One reason behind this difference, which manifests itself in teachers having become subject to higher level of direct administrative control by school managers while at the same time experiencing a more distinct loss of autonomy to evaluate their work, appears to be that medical doctors have been more successful in establishing themselves as experts in relation to new public audit agencies.

Place, publisher, year, edition, pages
Cambridge University Press, 2024
Keywords
NPM, welfare services, professionals, Sweden
National Category
Public Administration Studies
Identifiers
urn:nbn:se:uu:diva-528179 (URN)10.1017/S0047279422000228 (DOI)000780635000001 ()
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-01381
Available from: 2024-05-21 Created: 2024-05-21 Last updated: 2024-05-21Bibliographically approved
Hallberg, A., Winblad, U. & Fredriksson, M. (2024). Vertical policy coordination of COVID-19 testing in Sweden: an analysis of policy-specific demands and institutional barriers. Journal of Health Organization & Management, 38(9), 106-124
Open this publication in new window or tab >>Vertical policy coordination of COVID-19 testing in Sweden: an analysis of policy-specific demands and institutional barriers
2024 (English)In: Journal of Health Organization & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 38, no 9, p. 106-124Article in journal (Refereed) Published
Abstract [en]

Purpose

The build-up of large-scale COVID-19 testing required an unprecedented effort of coordination within decentralized healthcare systems around the world. The aim of the study was to elucidate the challenges of vertical policy coordination between non-political actors at the national and regional levels regarding this policy issue, using Sweden as our case.

Design/methodology/approach

Interviews with key actors at the national and regional levels were analyzed using an adapted version of a conceptualization by Adam et al. (2019), depicting barriers to vertical policy coordination.

Findings

Our results show that the main issues in the Swedish context were related to parallel sovereignty and a vagueness regarding responsibilities and mandates as well as complex governmental structures and that this was exacerbated by the unfamiliarity and uncertainty of the policy issue. We conclude that understanding the interaction between the comprehensiveness and complexity of the policy issue and the institutional context is crucial to achieving effective vertical policy coordination.

Originality/value

Many studies have focused on countries’ overall pandemic responses, but in order to improve the outcome of future pandemics, it is also important to learn from more specific response measures.

Place, publisher, year, edition, pages
Emerald Group Publishing Limited, 2024
Keywords
COVID-19 testing, Decentralization, Vertical policy coordination, Sweden, Healthcare governance
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Infectious Medicine
Identifiers
urn:nbn:se:uu:diva-526138 (URN)10.1108/jhom-09-2022-0278 (DOI)001185925200001 ()38494177 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2018-01578
Available from: 2024-04-04 Created: 2024-04-04 Last updated: 2024-04-05Bibliographically approved
Fredriksson, M., Gustafsson, I.-B. & Winblad, U. (2023). A New Way of Thinking and Talking About Economy: Clinic Managers' Perspectives on the Sustainable Implementation of a Decommissioning Programme in Sweden. HEALTH SERVICES INSIGHTS, 16, Article ID 11786329231189402.
Open this publication in new window or tab >>A New Way of Thinking and Talking About Economy: Clinic Managers' Perspectives on the Sustainable Implementation of a Decommissioning Programme in Sweden
2023 (English)In: HEALTH SERVICES INSIGHTS, ISSN 1178-6329, Vol. 16, article id 11786329231189402Article in journal (Refereed) Published
Abstract [en]

Healthcare systems may run into economic problems that may require 'active' decommissioning by policy-makers and managers. The aim of this study was to investigate, from a sustainability perspective, the implementation of an extensive decommissioning programme in one of the Swedish regions. Interviews were performed with 26 clinic managers 3 years after initial implementation. Those were analysed inductively, and then discussed based on a model of potential influences on sustainability. Although the programme was only 'partly sustained', the result point to a sustained attention to the health system's poor economy, visible in a great effort by the clinics to maintain their budgets. The most important influences were intervention fit and modifications made at the clinic level (i. innovation characteristics), clinic and health system leadership (ii. context), champions (iii. capacity) and shared decision-making and relationship building (iv. processes and interactions). When implementing decommissioning, it is particularly important to engage managers responsible for the care of patients and clinic budgets from an early stage and to allow them to design approaches based on the staff's and managers' detailed knowledge of the situation at their clinics and of the disease area, that is, to achieve fit at the clinics. In this way, the decommissioning approaches can more likely get the character of quality improvement efforts, which increases sustainability and may lead to positive quality outcomes. Despite being unpopular, the study suggests that decommissioning can have positive effects as well, such as creating opportunities to make difficult but necessary changes and fostering increased collegial support during the centralisation of services.

Place, publisher, year, edition, pages
SAGE Publications, 2023
Keywords
Decommissioning, sustainability, implementation, clinic managers, funding, healthcare system
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-508885 (URN)10.1177/11786329231189402 (DOI)001038386800001 ()37533504 (PubMedID)
Funder
Region Dalarna, LD16/01194
Available from: 2023-08-11 Created: 2023-08-11 Last updated: 2023-08-11Bibliographically approved
Ewert, B., Wallenburg, I., Winblad, U. & Bal, R. (2023). Any lessons to learn?: Pathways and impasses towards health system resilience in post-pandemic times. Health Economics, Policy and Law, 18(1), 66-81
Open this publication in new window or tab >>Any lessons to learn?: Pathways and impasses towards health system resilience in post-pandemic times
2023 (English)In: Health Economics, Policy and Law, ISSN 1744-1331, E-ISSN 1744-134X, Vol. 18, no 1, p. 66-81Article in journal (Refereed) Published
Abstract [en]

The COVID-19 pandemic has been an ultimate challenge for health systems as a whole rather than just single sectors (e.g. hospital care). Particularly, interface management between health system sectors and cooperation among stakeholders turned out to be crucial for an adequate crisis response. Dealing with such interfaces, it is argued in the literature, demands from health care systems to become resilient. One way to analyse this is to focus on the ways in which bottlenecks in health systems are dealt with during the pandemic. This paper investigates six bottlenecks, including overburdened public health agencies, neglected nursing homes and insufficient testing capacities that have been encountered in the health systems of Germany, Sweden and the Netherlands during the pandemic. Based on empirical findings we identify and critically discuss preliminary lessons in terms of health system resilience, an increasingly popular theoretical concept that frames crises as an opportunity for health system renewal. We argue that in practice health system resilience is hindered by path dependencies of national health systems and, owed to the crisis, interim policies that lack ambition for broader reforms.

Place, publisher, year, edition, pages
CAMBRIDGE UNIV PRESS, 2023
Keywords
COVID-19, Germany, health system, resilience, Sweden, the Netherlands
National Category
Public Health, Global Health, Social Medicine and Epidemiology Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-522925 (URN)10.1017/S1744133122000238 (DOI)001139077400005 ()36121039 (PubMedID)
Available from: 2024-02-13 Created: 2024-02-13 Last updated: 2024-02-13Bibliographically approved
Hoffstedt, C., Fredriksson, M., Winblad, U. & Holmström, I. K. (2023). Choosing not to choose - patients’ justification of a disengaged choice of primary care provider. Social Policy & Administration, 57(7), 1014-1031
Open this publication in new window or tab >>Choosing not to choose - patients’ justification of a disengaged choice of primary care provider
2023 (English)In: Social Policy & Administration, ISSN 0144-5596, E-ISSN 1467-9515, Vol. 57, no 7, p. 1014-1031Article in journal (Refereed) Published
Abstract [en]

A key underpinning of choice of health care provider is that patients make active and informed decisions which stimulate quality competition. By imitating the principles of a market in the steering of health care, patients thus assume the role of consumers. Few patients however neither consider alternative providers nor seek information about quality. The aim of this study was to investigate if and how patients engage in the role of being active and informed consumers in the setting of primary care, and how they argue for their choice. The study was based on semi-structured interviews with 18 respondents in a municipality in mid-Sweden. Respondents were purposefully sampled and interviews were analysed using an inductive thematic approach. Findings demonstrated that patients disengaged from choice by arguing, for instance, that they were satisfied with their current provider or because they perceived no differences in quality. Overall, results were in line with previous studies performed in US and European hospital settings, indicating that patients present some similar arguments regarding disengagement from choice irrespective of level of care or geographical setting. Arguments specifically related to the primary care level were that patients found it more important to achieve continuity in the patient-doctor relationship than ‘shopping around’ for the best provider, or that they desired more profiled services to actively make a choice. In contrast to previous literature, patients refuted the ‘patient-consumer’ role by referring to, for instance, the belief that care should be of equal quality independent of what choice they made.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
Keywords
Provider choice, Patient choice, Information search, Public reporting, Primary care, Pragmatic Sociology of Critique, Thematic analysis, Sweden
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Health Care Research
Identifiers
urn:nbn:se:uu:diva-470627 (URN)10.1111/spol.12915 (DOI)000978598700001 ()
Available from: 2022-03-28 Created: 2022-03-28 Last updated: 2024-02-27Bibliographically approved
Åhlfeldt, E., Isaksson, D. & Winblad, U. (2023). Factors Explaining Program Sustainability: A Study of the Implementation of a Social Services Program in Sweden. Health & Social Care in the Community, 2023, Article ID 1458305.
Open this publication in new window or tab >>Factors Explaining Program Sustainability: A Study of the Implementation of a Social Services Program in Sweden
2023 (English)In: Health & Social Care in the Community, ISSN 0966-0410, E-ISSN 1365-2524, Vol. 2023, article id 1458305Article in journal (Refereed) Published
Abstract [en]

Even for successfully implemented programs, there is a great risk that new work practices are not sustained over time. Previous research has yielded a number of factors which influence program sustainability, but little is known about which factors are most important in different contexts or how these factors interact. This study tests a model of sustainability factors in a case where a program for structured needs assessment and documentation was implemented in the Swedish social services. In November 2020, a questionnaire was sent out to local implementing actors in the municipalities. The data include 135 municipal organizations with 1–3 respondents per organization. Descriptive statistics and multiple regression were used in the analysis. The outcome variable was routinization as one of the most central components of sustainability. The findings show that while the program was implemented at 21.5% of sites, it was both implemented and routinized at only 13.3% of sites. A key factor for successful routinization was an open project strategy, which entails coordination between the implementation process and other change initiatives, the identification of a long-term planning horizon, and development based on continuous feedback. Additional factors found to contribute to routinization were management commitment, user participation, first-line manager commitment, and available resources. Certain factors were identified as pertinent to the implementing actors themselves, such as effective project leadership and rationally planned projects. These latter factors, however, demonstrated less importance towards routinization. These findings are discussed in relation to the fragmented context of the implementation, whereby the recipient organizations were not single, unified organizations, but rather organizational clusters involving both purchaser and provider organizations. The findings have implications for the planning, management, and evaluation of social program implementation and the ability to sustain novel work practices.

Place, publisher, year, edition, pages
Hindawi Publishing Corporation, 2023
Keywords
Sustainability, Routinization, Implementation, Organizational change, Social care, Survey research
National Category
Social Work
Identifiers
urn:nbn:se:uu:diva-498743 (URN)10.1155/2023/1458305 (DOI)000939316300001 ()
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2019-01494
Available from: 2023-03-20 Created: 2023-03-20 Last updated: 2023-04-03Bibliographically approved
Wallenburg, I., Friebel, R., Winblad, U., Pujolras, L. M. & Bal, R. (2023). 'Nurses are seen as general cargo, not the smart TVs you ship carefully': the politics of nurse staffing in England, Spain, Sweden, and the Netherlands. Health Economics, Policy and Law, 18(4), 411-425
Open this publication in new window or tab >>'Nurses are seen as general cargo, not the smart TVs you ship carefully': the politics of nurse staffing in England, Spain, Sweden, and the Netherlands
Show others...
2023 (English)In: Health Economics, Policy and Law, ISSN 1744-1331, E-ISSN 1744-134X, Vol. 18, no 4, p. 411-425Article in journal (Refereed) Published
Abstract [en]

Nurse workforce shortages put healthcare systems under pressure, moving the nursing profession into the core of healthcare policymaking. In this paper, we shift the focus from workforce policy to workforce politics and highlight the political role of nurses in healthcare systems in England, Spain, Sweden, and the Netherlands. Using a comparative discursive institutionalist approach, we study how nurses are organised and represented in these four countries. We show how nurse politics plays out at the levels of representation, working conditions, career building, and by breaking with the public healthcare system. Although there are differences between the countries - with nurses in England and Spain under more pressure than in the Netherlands and Sweden - nurses are often not represented in policy discourses; not just because of institutional ignorance but also because of fragmentation of the profession itself. This institutional ignorance and lack of collective representation, we argue, requires attention to foster the role and position of nurses in contemporary healthcare systems.

Place, publisher, year, edition, pages
Cambridge University Press, 2023
Keywords
discursive institutionalism, institutional ignorance, nurse politics, workforce shortage
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-515596 (URN)10.1017/S1744133123000178 (DOI)001084348200007 ()37702051 (PubMedID)
Available from: 2023-11-08 Created: 2023-11-08 Last updated: 2023-11-08Bibliographically approved
Spangler, D., Linder, W. & Winblad, U. (2023). The Impact of the Swedish Care Coordination Act on Hospital Readmission and Length-of-Stay among Multi-Morbid Elderly Patients: A Controlled Interrupted Time Series Analysis. International Journal of Integrated Care, 23(2), Article ID 17.
Open this publication in new window or tab >>The Impact of the Swedish Care Coordination Act on Hospital Readmission and Length-of-Stay among Multi-Morbid Elderly Patients: A Controlled Interrupted Time Series Analysis
2023 (English)In: International Journal of Integrated Care, E-ISSN 1568-4156, Vol. 23, no 2, article id 17Article in journal (Refereed) Published
Abstract [en]

Coordinating follow-up care after discharge from hospital is critical to ensuring good outcomes for patients, but is difficult when multiple care providers are involved. In 2018, Sweden adopted the Care Coordination Act, which modified economic incentives to reduce discharge delays and mandated a discharge planning process for patients requiring post-discharge social-or primary care services. This study evaluates the impact of this reform on hospital length-of-stay and unplanned readmissions among multi-morbid elderly patients. Interrupted time series analysis of all in-patient care episodes involving multi-morbid elderly patients in Sweden from 2015 - 2019 (n = 2 386 039) was performed. Secondary analyses using case-mix adjustment and controlled interrupted time series analysis were employed to assess for bias. Average length of stay decreased during the post-reform period, corresponding to 248 521 saved care days. Unplanned readmissions meanwhile increased, corresponding to 7 572 excess unplanned readmissions. While reductions in length-of-stay were concentrated among patients targeted by the reform, increases in readmission rates were similar in patients not targeted by the reform, indicating potential confounding. The reform thus appears to have achieved its goal of decreasing in-patient length of stay, but a robust effect on readmissions, outpatient visits, or mortality was not found. This may be due to lackluster implementation or an ineffective mandated intervention.

Place, publisher, year, edition, pages
Ubiquity Press, 2023
Keywords
care coordination, care integration, health policy, readmission, length of stay, multi-morbid elderly patients
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Geriatrics
Identifiers
urn:nbn:se:uu:diva-510641 (URN)10.5334/ijic.6510 (DOI)001048320400001 ()37250760 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2021-00678
Available from: 2023-09-04 Created: 2023-09-04 Last updated: 2023-09-04Bibliographically approved
Holmström, I., Kaminsky, E., Lindberg, Y., Spangler, D. & Winblad, U. (2022). Better safe than sorry: Registered nurses' strategies for handling difficult calls to emergency medical dispatch centres - An interview study. Journal of Clinical Nursing, 31(17-18), 2486-2494
Open this publication in new window or tab >>Better safe than sorry: Registered nurses' strategies for handling difficult calls to emergency medical dispatch centres - An interview study
Show others...
2022 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 31, no 17-18, p. 2486-2494Article in journal (Refereed) Published
Abstract [en]

Aims and objectives To describe strategies employed by registered nurses for handling difficult calls to emergency medical dispatch centres.

Background At emergency medical dispatch centres, registered nurses encounter a range of difficult calls in their clinical practice. They often use clinical decision support systems, but these may be of limited help if the caller is for instance abusive or has limited language proficiency. Much can be learnt from strategies developed by registered nurses for handling difficult calls.

Design A descriptive qualitative study was conducted.

Methods A purposeful sample of 24 registered nurses from three different emergency medical dispatch centres were interviewed. The transcribed interviews were analysed using qualitative content analysis. The COREQ checklist was applied.

Results An overarching theme was established: "Using one's nursing competence and available resources for a safe outcome", based on three sub-themes: Use one's own professional and personal resources, Use resources within the organisation and Use external resources. The themes in turn consist of ten categories.

Conclusions Registered nurses employed a range of strategies to deal with difficult calls, often in combination. They used their personal resources, resources within their own organisation, and collaboration partners to make safe triage decisions and use resources wisely. The effectiveness of these strategies, however, remains unknown. When registered nurses were unable to rule out a high-acuity condition, they used safety-netting and sent an ambulance. Evaluating current strategies and making strategies explicit could further improve the ability of nurses to handle difficult calls.

Relevance to clinical practice The strategies described by registered nurses for handling difficult calls to EMDCs included using a consecutive set of strategies. Some of the strategies seemed to be used deliberately, while others seemed tacit and applied in a routinised way. These strategies could potentially be useful for RNs working with telephone triage in different contexts.

Place, publisher, year, edition, pages
John Wiley & SonsWiley, 2022
Keywords
communication, emergency calls, emergency medical dispatch, interviews, telephone triage, content analysis
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-484676 (URN)10.1111/jocn.16061 (DOI)000701287100001 ()34570927 (PubMedID)
Funder
Vinnova, 2017--04652
Available from: 2022-09-16 Created: 2022-09-16 Last updated: 2024-01-15Bibliographically approved
Blomqvist, P. & Winblad, U. (2022). Contracting out welfare services: how are private contractors held accountable?. Public Management Review, 24(2), 233-254
Open this publication in new window or tab >>Contracting out welfare services: how are private contractors held accountable?
2022 (English)In: Public Management Review, ISSN 1471-9037, E-ISSN 1471-9045, Vol. 24, no 2, p. 233-254Article in journal (Refereed) Epub ahead of print
Abstract [en]

A challenge for governments contracting out public services is holding accountable contractors who fail to meet agreed-upon standards. In social services, contract monitoring is complicated by the fact that contracts tend to be incomplete and performance hard to assess. In this study, we examine how local governments in Sweden hold private contractors accountable in nursing home care. The main finding is that a mixture of accountability mechanisms was used, but that social accountability was seen as most effective. Marketaccountability measures like contract termination and financial sanctions could not be applied as local governments lacked the capacity to enforce them

Place, publisher, year, edition, pages
Taylor & Francis, 2022
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-431000 (URN)10.1080/14719037.2020.1817530 (DOI)000573142200001 ()
Available from: 2021-01-13 Created: 2021-01-13 Last updated: 2023-07-21Bibliographically approved
Projects
How can public authorities monitor private social service providers? [2011-01382_VR]; Uppsala UniversityChoice Within Primary Health Care - How is Equity Affected? [2011-01137_Forte]; Uppsala UniversityWhy no Third Sector in Swedish Elder Care? [P11-0889:1_RJ]; Uppsala UniversityAgeing: What explains quality within Swedish eldercare today? [2014-05134_Forte]; Uppsala UniversityCoordinating care for the frail elderly in Sweden: why so difficult? [2018-00783_Forte]; Uppsala UniversityInter-organizational coordination to improve clinical outcomes for discharged elderly patients - A systematic review [2020-01283_Forte]; Uppsala UniversityCare collaboration for the elderly – how do we create sustainable changes after Covid-19? [2020-01577_Forte]; Uppsala University
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-3921-5522

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