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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 124) Show all publications
Tyler, D. A., Gadbois, E. A., McHugh, J. P., Shield, R. R. & Winblad, U. (2020). Using Multiple Case Studies to Understand Organization and Patient Perspectives on Transitions of Care Between Hospitals and Nursing Homes. SAGE research methods cases
Open this publication in new window or tab >>Using Multiple Case Studies to Understand Organization and Patient Perspectives on Transitions of Care Between Hospitals and Nursing Homes
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2020 (English)In: SAGE research methods casesArticle in journal (Refereed) Published
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-406475 (URN)10.4135/9781529720068 (DOI)
Available from: 2020-03-09 Created: 2020-03-09 Last updated: 2020-03-09
Shield, R., Winblad, U., McHugh, J., Gadbois, E. & Tyler, D. (2019). Choosing the Best and Scrambling for the Rest: Hospital–Nursing Home Relationships and Admissions to Post-Acute Care. Journal of Applied Gerontology, 38(4), 479-498
Open this publication in new window or tab >>Choosing the Best and Scrambling for the Rest: Hospital–Nursing Home Relationships and Admissions to Post-Acute Care
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2019 (English)In: Journal of Applied Gerontology, ISSN 0733-4648, E-ISSN 1552-4523, Vol. 38, no 4, p. 479-498Article in journal (Refereed) Published
Abstract [en]

Objective: We explored post-Affordable Care Act hospital and skilled nursing facility (SNF) perspectives in discharge and admission practices. Method: Interviews were conducted with 138 administrative personnel in 16 hospitals and 25 SNFs in eight U.S. markets and qualitatively analyzed. Results: Hospitals may use prior referral rates and patients' geographic proximity to SNFs to guide discharges. SNFs with higher hospital referral rates often use licensed nurses to screen patients to admit more preferred patients. While SNFs with lower hospital referral rates use marketing strategies to increase admissions, these patients are often less preferred due to lower reimbursement or complex care needs. Conclusion: An unintended consequence of increased hospital-SNF integration may be greater disparity. SNFs with high hospital referral rates may admit well-reimbursed or less medically complex patients than SNFs with lower referral rates. Without policy remediation, SNFs with lower referral rates may thus care for more medically complex long-term care patients.

Keywords
post-acute care, qualitative and mixed methods, impact of health care policy
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-343260 (URN)10.1177/0733464817752084 (DOI)000461200900005 ()29307258 (PubMedID)
Available from: 2018-02-26 Created: 2018-02-26 Last updated: 2019-05-06Bibliographically approved
Fredriksson, M., Gustafsson, I.-B. & Winblad, U. (2019). Cuts without conflict: The use of political strategy in local health system retrenchment in Sweden. Social Science and Medicine, 237, Article ID 112464.
Open this publication in new window or tab >>Cuts without conflict: The use of political strategy in local health system retrenchment in Sweden
2019 (English)In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 237, article id 112464Article in journal (Refereed) Published
Abstract [en]

Disinvestment in health services is seen as challenging by decision-makers as the public usually reacts strongly to rationing and retrenchments. Drawing on the literature on welfare state retrenchment - the reduction of public expenditure by cutting costs or spending - this article explores the development and implementation of a comprehensive retrenchment programme in one local health system in Sweden (a so-called region). According to theory, retrenchments are both electorally risky and institutionally difficult. Nonetheless, they take place and in the local health system we investigate, without too extensive public protest and without decision-makers having to resign. The main question in this qualitative study is: why and how was it possible to make such comprehensive retrenchments despite being unpopular and facing many political and institutional barriers? Interviews with 18 local politicians and public servants were carried out between January 18 and April 3, 2017, and analysed from the perspective of political strategy. They showed that the serious budget deficit, and a shared understanding of what the region's problems were, are important explanations for why the retrenchment programme was possible to develop and implement. Based on a thorough internal review of the health system, a crisis discourse developed which partly depoliticized the retrenchment programme. Justification and framing are keys to how it was possible. The retrenchment programme was justified by arguing that current service provision exceeded that in comparable regions, and framed as necessary saving the local health system and enhancing quality. Important strategies were thus to redefine the retrenchments and to blame-share, the latter through politicians and public servants claiming responsibility together after involving the clinic managers. In sum, our study shows that the retrenchment literature and theories on political strategy may be fruitfully applied to the health-care sector as well. By studying the local level, our findings contribute to the retrenchment literature, indicating that political strategy at the local level is more about justification and blame sharing, than blame avoidance.

Keywords
Sweden, Disinvestment, Retrenchment, Rationing, Political strategy, Blame avoidance, Blame sharing, Local health system
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-394974 (URN)10.1016/j.socscimed.2019.112464 (DOI)000485852200026 ()31430657 (PubMedID)
Available from: 2019-10-11 Created: 2019-10-11 Last updated: 2019-10-11Bibliographically approved
Wisell, K., Winblad, U. & Kälvemark Sporrong, S. (2019). Diversity as salvation?: A comparison of the diversity rationale in the Swedish pharmacy ownership liberalization reform and the primary care choice reform. Health Policy, 123(5), 457-461
Open this publication in new window or tab >>Diversity as salvation?: A comparison of the diversity rationale in the Swedish pharmacy ownership liberalization reform and the primary care choice reform
2019 (English)In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 123, no 5, p. 457-461Article in journal (Refereed) Published
Abstract [en]

Widespread liberalizing reform of the Swedish community pharmacy and primary care sectors took place in 2009–2010, including opening the market to private providers. One important rationale for the reforms was to increase diversity in the health-care system by providing more choices for individuals. The aim of this study was to increase the understanding how policy makers understood and defined diversity as a concept, and as a rationale for the reforms. The method used was document analysis of preparatory work and plenary parliament debate protocols. The results show that policy makers held vague and unclear definitions of diversity, which complicated its implementation. Diversity was sometimes seen as an effect of competition–a goal–while in other cases it was seen as a condition to be met in order to achieve competition–a means. Thus, policy makers viewed diversity both as a goal and as a means, making the underlying mechanisms unclear. The findings also revealed that policy makers failed to consistently demonstrate how the introduction of competition would lead to diversity.

Keywords
Community pharmacy, Community health care, Regulations, Liberalization, Sweden, Diversity
National Category
Pharmaceutical Sciences
Research subject
Social Pharmacy
Identifiers
urn:nbn:se:uu:diva-380072 (URN)10.1016/j.healthpol.2019.03.005 (DOI)000468719700003 ()30890380 (PubMedID)
Available from: 2019-03-23 Created: 2019-03-23 Last updated: 2019-06-24Bibliographically approved
Egholm, C. L., Helmark, C., Christensen, J., Eldh, A. C., Winblad, U., Bunkenborg, G., . . . Nilsen, P. (2019). Facilitators for using data from a quality registry in local quality improvement work: a cross-sectional survey of the Danish Cardiac Rehabilitation Database. BMJ Open, 9(6), Article ID e028291.
Open this publication in new window or tab >>Facilitators for using data from a quality registry in local quality improvement work: a cross-sectional survey of the Danish Cardiac Rehabilitation Database
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2019 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 6, article id e028291Article in journal (Refereed) Published
Abstract [en]

Objectives To investigate use of data from a clinical quality registry for cardiac rehabilitation in Denmark, considering the extent to which data are used for local quality improvement and what facilitates the use of these data, with a particular focus on whether there are differences between frontline staff and managers. Design Cross-sectional nationwide survey study. Setting, methods and participants A previously validated, Swedish questionnaire regarding use of data from clinical quality registries was translated and emailed to frontline staff, mid-level managers and heads of departments (n=175) in all 30 hospital departments participating in the Danish Cardiac Rehabilitation Database. Data were analysed descriptively and through multiple linear regression. Results Survey response rate was 58% (101/175). Reports of registry use at department level (measured through an index comprising seven items; score min 0, max 7, where a low score indicates less use of data) varied significantly between groups of respondents: frontline staff mean score 1.3 (SD=2.0), mid-level management mean 2.4 (SD=2.3) and heads of departments mean 3.0 (SD=2.5), p=0.006. Overall, department level use of data was positively associated with higher perceived data quality and usefulness (regression coefficient=0.22, p=0.019), management request for data (regression coefficient=0.40, p=0.008) and personal motivation of the respondent (regression coefficient=1.63, p<0.001). Among managers, use of registry data was associated with data quality and usefulness (regression coefficient=0.43, p=0.027), and among frontline staff, reported data use was associated with management involvement in quality improvement work (regression coefficient=0.90, p=0.017) and personal motivation (regression coefficient=1.66, p<0.001). Conclusions The findings suggest relatively sparse use of data in local quality improvement work. A complex interplay of factors seem to be associated with data use with varying aspects being of importance for frontline staff and managers.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
National Category
Occupational Health and Environmental Health Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-389818 (URN)10.1136/bmjopen-2018-028291 (DOI)000471197000083 ()31196902 (PubMedID)
Available from: 2019-07-30 Created: 2019-07-30 Last updated: 2019-07-30Bibliographically approved
Kullberg, L., Blomqvist, P. & Winblad, U. (2019). Health insurance for the healthy?: Voluntary health insurance in Sweden. Health Policy, 123(8), 737-746
Open this publication in new window or tab >>Health insurance for the healthy?: Voluntary health insurance in Sweden
2019 (English)In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 123, no 8, p. 737-746Article in journal (Refereed) Published
Abstract [en]

Background: In Sweden, voluntary health insurance is held only by a very small part of the population, but uptake has grown rapidly since 2000. So far, little is known about who purchases this insurance and what the insurance plans contain.

Aim: To provide a comprehensive description of the coverage and content of voluntary health insurance in Sweden.

Methods: Data from a national survey (Riks-SOM 2016) were used to estimate insurance coverage in different population groups. Additionally, a qualitative content analysis of the voluntary health insurance plans from seven of the largest insurance companies in Sweden was conducted.

Results: Voluntary health insurance was found to be more common among high income-earners, individuals employed in the private sector, business owners, and white-collar workers. Insurance benefits varied from visiting a general practitioner to more specialised treatments like knee or hip surgery. Pre-existing medical conditions, emergency medicine, highly specialised care and ongoing chronic care was excluded from the insurance plans.

Conclusion: Work-related factors such as employment sector, occupation and income appeared to be key determinants for VHI uptake in Sweden. Since the insurance plans included several restrictions, individuals with high care needs are excluded. Taken together, the results indicate that voluntary health insurance in Sweden provide benefits foremost for the healthy and wealthy.

Keywords
Voluntary health insurance, Sweden, Private healthcare, Access to healthcare, Health plans, Private health insurance
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-393122 (URN)10.1016/j.healthpol.2019.06.004 (DOI)000478713300007 ()31300174 (PubMedID)
Available from: 2019-09-24 Created: 2019-09-24 Last updated: 2019-09-24Bibliographically approved
Gadbois, E. A., Tyler, D. A., Shield, R., McHugh, J., Winblad, U., Teno, J. M. & Mor, V. (2019). Lost in Transition: a Qualitative Study of Patients Discharged from Hospital to Skilled Nursing Facility. Journal of general internal medicine, 34(1), 102-109
Open this publication in new window or tab >>Lost in Transition: a Qualitative Study of Patients Discharged from Hospital to Skilled Nursing Facility
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2019 (English)In: Journal of general internal medicine, ISSN 0884-8734, E-ISSN 1525-1497, Vol. 34, no 1, p. 102-109Article in journal (Refereed) Published
Abstract [en]

Objective

This research aimed to understand the experiences of patients transitioning from hospitals to skilled nursing facilities (SNFs) by eliciting views from patients and hospital and skilled nursing facility staff.

Design

We conducted semi-structured interviews with hospital and skilled nursing facility staff and skilled nursing facility patients and their family members in an attempt to understand transitions between hospital and SNF. These interviews focused on all aspects of the discharge planning and nursing facility placement processes including who is involved, how decisions are made, patients' experiences, hospital-SNF communication, and the presence of programs to improve the transition process.

Participants

Participants were 138 staff in 16 hospitals and 25 SNFs in 8 markets across the country, and 98 newly admitted, previously community-dwelling SNF patients and/or their family members in five of those markets.

Approach

Interviews were qualitatively analyzed to identify overarching themes.

Key Results

Patients reported they felt rushed in making their SNF decisions, did not feel they were appropriately prepared for the hospital-SNF transition or educated about their post-acute needs, and experienced transitions that felt chaotic, with complications they associated with timing and medications. Hospital and SNF staff expressed similar opinions, stating that transitions were rushed, there were problems with the timing of the discharge, with information transfer and medication reconciliation, and that patients were not appropriately prepared for the transition. Staff at some facilities reported programs designed to address these problems, but the efficacy of these programs is unknown.

Conclusions

Results indicate problematic transitions stemming from insufficient care coordination and failure to appropriately prepare patients and their family members. Previous research suggests that problematic or hurried transitions from hospital to SNF are associated with medication errors and unnecessary rehospitalizations. Interventions to improve transitions from hospital to SNF that include a focus on patients and families are needed.

National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-368032 (URN)10.1007/s11606-018-4695-0 (DOI)000454888300025 ()30338471 (PubMedID)
Available from: 2018-12-03 Created: 2018-12-03 Last updated: 2019-01-28Bibliographically approved
Gofen, A., Blomqvist, P., Needham, C. E., Warren, K. & Winblad, U. (2019). Negotiated compliance at the street level: Personalizing immunization in England, Israel and Sweden. Public Administration, 97(1), 195-209
Open this publication in new window or tab >>Negotiated compliance at the street level: Personalizing immunization in England, Israel and Sweden
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2019 (English)In: Public Administration, ISSN 0033-3298, E-ISSN 1467-9299, Vol. 97, no 1, p. 195-209Article in journal (Refereed) Published
Abstract [en]

Often portrayed as behaviour that is inconsistent with policy goals, public noncompliance poses a significant challenge for government. To explore what compliance efforts entail on the ground, this study focuses on childhood immunization as a paradigmatic case where a failure to ensure compliance poses a public health risk. The analysis draws on 48 semi‐structured interviews with frontline nurses and regional/national public health officials in England (N = 15), Sweden (N = 17) and Israel (N = 16), all of which have experienced periodic noncompliance spikes, but differ in direct delivery of vaccination provision. Compliance efforts emerged as a joint decision‐making process in which improvisatory practices of personalized appeals are deployed to accommodate parents’ concerns, termed here ‘street‐level negotiation’. Whereas compliance is suggestive of compelling citizens’ adherence to standardized rules, compliance negotiation draws attention to the limited resources street‐level workers have when encountering noncompliance and to policy‐clients’ influence on delivery arrangements when holding discretionary power over whether or not to comply.

Place, publisher, year, edition, pages
WILEY, 2019
National Category
Public Administration Studies
Identifiers
urn:nbn:se:uu:diva-383004 (URN)10.1111/padm.12557 (DOI)000464433000013 ()
Available from: 2019-05-21 Created: 2019-05-21 Last updated: 2019-05-21Bibliographically approved
Vengberg, S., Fredriksson, M. & Winblad, U. (2019). Patient choice and provider competition: Quality enhancing drivers in primary care?. Social Science and Medicine, 226, 217-224
Open this publication in new window or tab >>Patient choice and provider competition: Quality enhancing drivers in primary care?
2019 (English)In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 226, p. 217-224Article in journal (Refereed) Published
Abstract [en]

Patient choice of provider and provider competition have been introduced with the claim that they would lead to improved quality. For this to occur, certain conditions must be fulfilled on both the demand and the supply side. However, supply side-mechanisms – with provider behaviour as central – have been largely neglected in the literature, especially in primary care markets. In this article, we focus on provider behaviour and explore if and how choice and competition function as quality enhancing drivers in Swedish primary care. We explore this through semi-structured interviews with 24 managers and physicians at 13 Swedish primary healthcare centres, conducted from May 2016 to February 2017. The analysis draws on assumptions that for enhanced quality, providers must receive information on patients' choices, analyse it and respond accordingly. One conclusion is that Swedish primary care providers lack information on patients' choices and "exits", which makes it difficult for providers to respond to patients' choices. Furthermore, it is questionable whether choice and competition stimulate enhanced clinical quality. At the same time, choice and competition seems to make providers more aware of accessibility concerns and of their reputation, which they may be stimulated to improve. The article contributes evidence on supply side-mechanisms, and encourages clarification of "quality" in this respect, both on the political arena as well as in theoretical models.

Keywords
Sweden, Patient choice, Competition, Quasi-market, Primary care
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-379412 (URN)10.1016/j.socscimed.2019.01.042 (DOI)000466251700025 ()30878640 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-4763
Available from: 2019-03-15 Created: 2019-03-15 Last updated: 2019-06-20Bibliographically approved
Spangler, D., Blomqvist, P., Lindberg, Y. & Winblad, U. (2019). Small is beautiful?: Explaining resident satisfaction in Swedish nursing home care. BMC Health Services Research, 19(1), Article ID 886.
Open this publication in new window or tab >>Small is beautiful?: Explaining resident satisfaction in Swedish nursing home care
2019 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 19, no 1, article id 886Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Resident satisfaction is an important aspect of nursing home quality. Despite this, few studies have systematically investigated what aspects of nursing home care are most strongly associated with satisfaction. In Sweden, a large number of processual and structural measures are collected to describe the quality of nursing home care, though the impact of these measures on outcomes including resident satisfaction is poorly understood.

METHODS: A cross-sectional analysis of data collected in two nationally representative surveys of Swedish eldercare quality using multi-level models to account for geographic differences.

RESULTS: Of the factors examined, nursing home size was found to be the most important predictor of resident satisfaction, followed by the amount of exercise and activities offered by the nursing home. Measures of individualized care processes, ownership status, staffing ratios, and staff education levels were also weakly associated with resident satisfaction. Contrary to previous research, we found no clear differences between processual and structural variables in terms of their association with resident satisfaction.

CONCLUSIONS: The results suggest that of the investigated aspects of nursing home care, the size of the nursing home and the amount activities offered to residents were the strongest predictors of satisfaction. Investigation of the mechanisms behind the higher levels of satisfaction found at smaller nursing homes may be a fruitful avenue for further research.

Keywords
Eldercare, Nursing home, Quality, Satisfaction, Sweden
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-398400 (URN)10.1186/s12913-019-4694-9 (DOI)000506197700002 ()31766998 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-05134
Available from: 2019-12-05 Created: 2019-12-05 Last updated: 2020-03-24Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-3921-5522

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