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Winblad, Ulrika
Alternative names
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 111) Show all publications
Tyler, D. A., McHugh, J. P., Shield, R. R., Winblad, U., Gadbois, E. A. & Mor, V. (2018). Challenges and Consequences of Reduced Skilled Nursing Facility Lengths of Stay. Health Services Research
Open this publication in new window or tab >>Challenges and Consequences of Reduced Skilled Nursing Facility Lengths of Stay
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2018 (English)In: Health Services Research, ISSN 1475-6773Article in journal (Refereed) Published
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-360832 (URN)10.1111/1475-6773.12987 (DOI)
Available from: 2018-09-18 Created: 2018-09-18 Last updated: 2018-09-18
Shield, R., Winblad, U., McHugh, J., Gadbois, E. & Tyler, D. (2018). Choosing the Best and Scrambling for the Rest: Hospital–Nursing Home Relationships and Admissions to Post-Acute Care. Journal of Applied Gerontology
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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2018 (English)In: Journal of Applied Gerontology, ISSN 0733-4648, E-ISSN 1552-4523Article in journal (Refereed) Published
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)
Available from: 2018-02-26 Created: 2018-02-26 Last updated: 2018-02-26
Kullberg, L., Blomqvist, P. & Winblad, U. (2018). Market-orienting reforms in rural health care in Sweden: how can equity in access be preserved?. International Journal for Equity in Health, 17, Article ID 123.
Open this publication in new window or tab >>Market-orienting reforms in rural health care in Sweden: how can equity in access be preserved?
2018 (English)In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 17, article id 123Article in journal (Refereed) Published
Abstract [en]

Background: Health care provision in rural and urban areas faces different challenges. In Sweden, health care provision has been predominantly public and equitable access to care has been pursued mainly through public planning and coordination. This is to ensure that health needs are met in the same manner in all parts of the country, including rural or less affluent areas. However, a marketization of the health care system has taken place during recent decades and the publicly planned system has been partially replaced by a new market logic, where private providers guided by financial concerns can decide independently where to establish their practices. In this paper, we explore the effects of marketization policies on rural health care provision by asking how policy makers in rural counties have managed to combine two seemingly contradictory health policy goals: to create conditions for market competition among health care providers and to ensure equal access to health care for all patients, including those living in rural and remote areas. Methods: A qualitative case study within three counties in the northern part of Sweden, characterized by vast rural areas, was carried out. Legal documents, the "accreditation documents" regulating the health care quasi-markets in the three counties were analyzed. In addition, interviews with policy makers in the three county councils, representing the political majority, the opposition, and the political administration were conducted in April and May 2013. Results: The findings demonstrate the difficulties involved in introducing market dynamics in health care provision in rural areas, as these reforms not only undermined existing resource allocation systems based on health needs but also undercut attempts by local policy makers to arrange for care provision in remote locations through planning and coordination. Conclusion: Provision of health care in rural areas is not well suited for market reforms introducing competition, as this may undermine the goal of equity in access to health care, even in a publicly financed health care system.

Keywords
Rural health care, Marketization, Patient choice, Health care planning, Health governance, Sweden
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-362645 (URN)10.1186/s12939-018-0819-8 (DOI)000441946700002 ()30119665 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, Dnr 2011-01137
Available from: 2018-10-09 Created: 2018-10-09 Last updated: 2018-10-09Bibliographically approved
Isaksson, D., Blomqvist, P. & Winblad, U. (2018). Privatization of social care delivery –: how can contracts be specified?. Public Management Review, 20(11), 1643-1662
Open this publication in new window or tab >>Privatization of social care delivery –: how can contracts be specified?
2018 (English)In: Public Management Review, ISSN 1471-9037, E-ISSN 1471-9045, Vol. 20, no 11, p. 1643-1662Article in journal (Refereed) Published
Abstract [en]

ABSTRACT

When contracting out services to private actors, public authorities must be able to ensure that the quality of services provided is satisfactory. Therefore, it is important to formulate precise quality requirements, thus making them possible to monitor. In the study, 1,005 quality requirements from public procurements of nursing homes were categorized, and their degree of monitorability assessed. The analysis showed that quality requirements related to ‘soft’ areas such as social activities typically were non-monitorable. The requirements were written in an imprecise, vague manner, thus making it difficult for the local governments to determine whether or not they were met.

KEYWORDS: Contracting, public procurement, elder care, quality, social services

National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-354473 (URN)10.1080/14719037.2017.1417465 (DOI)
Available from: 2018-06-20 Created: 2018-06-20 Last updated: 2018-09-26Bibliographically approved
Moberg, L., Blomqvist, P. & Winblad, U. (2018). Professionalized through audit?: Care workers and the new audit regime in Sweden. Social Policy & Administration, 52(3), 631-645
Open this publication in new window or tab >>Professionalized through audit?: Care workers and the new audit regime in Sweden
2018 (English)In: Social Policy & Administration, ISSN 0144-5596, E-ISSN 1467-9515, Vol. 52, no 3, p. 631-645Article in journal (Refereed) Published
Abstract [en]

The professionalization of social care workers is a policy goal in many welfare states. At the same time, professionalization risks being undermined by enhanced audit. The objective of this article is to analyze whether the audit processes adopted in Swedish eldercare and childcare support or undermine the professionalization of the occupations working there, i.e., nurses, nursing assistants, preschool teachers, and preschool assistants. In particular, we investigate whether the three main forms of auditstandard-setting, inspections, and quality measurementssupport or undermine the occupations' ability to achieve professional closure and enhance their external and internal autonomy. The findings suggest that audit processes in eldercare risk undermining professionalization, while in childcare the pattern is reversed: audit appears supportive of professionalization, at least for preschool teachers. This finding suggests that audit processes do not have to be detrimental to professionalization.

Keywords
Professionalization, Audit, Social care, Eldercare, Child care
National Category
Social Sciences Public Administration Studies
Identifiers
urn:nbn:se:uu:diva-319246 (URN)10.1111/spol.12367 (DOI)000430084700005 ()
Funder
Swedish Research Council, 421-2011-1382
Available from: 2017-04-02 Created: 2017-04-02 Last updated: 2018-06-19Bibliographically approved
Törmä, J., Winblad, U., Saletti, A. & Cederholm, T. (2018). The effects of nutritional guideline implementation on nursing home staff performance: a controlled trial. Scandinavian Journal of Caring Sciences, 32(2), 622-633
Open this publication in new window or tab >>The effects of nutritional guideline implementation on nursing home staff performance: a controlled trial
2018 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 32, no 2, p. 622-633Article in journal (Refereed) Published
Abstract [en]

Rationale: Suboptimal nutritional practices in elderly caresettings may be resolved by an efficient introduction ofnutritional guidelines.Aims: To compare two different implementation strate-gies, external facilitation (EF) and educational outreachvisits (EOVs), when introducing nutritional guidelines innursing homes (NHs), and study the impact on staffperformance.Methodological design: A quasi-experimental study withbaseline and follow-up measurements.Outcome measures: The primary outcome was staff perfor-mance as a function of mealtime ambience and food ser-vice routines.Interventions/research methods: The EF strategy was a 1-year,multifaceted intervention that included support, guidance,practice audit and feedback in two NH units. The EOVstrategy comprised one-three-hour lecture about nutri-tional guidelines in two other NH units. Both strategieswere targeted to selected NH teams, which consisted of aunit manager, a nurse and 5–10 care staff. Mealtime ambi-ence was evaluated by 47 observations using a structuredmealtime instrument. Food service routines were evalu-ated by 109 food records performed by the staff.Results: Mealtime ambience was more strongly improvedin the EF group than in the EOV group after the imple-mentation. Factors improved were laying a table(p = 0.03), offering a choice of beverage (p = 0.02), theserving of the meal (p = 0.02), interactions between staffand residents (p = 0.02) and less noise from the kitchen(p = 0.01). Food service routines remained unchanged inboth groups.Conclusions: An EF strategy that included guidance, auditand feedback improved mealtime ambience when nutri-tional guidelines were introduced in a nursing home set-ting, whereas food service routines were unchanged bythe EF strategy.

National Category
Nutrition and Dietetics
Identifiers
urn:nbn:se:uu:diva-312221 (URN)10.1111/scs.12487 (DOI)000436254800018 ()
Available from: 2017-01-08 Created: 2017-01-08 Last updated: 2018-08-30Bibliographically approved
Hoffstedt, C., Fredriksson, M., Lenhoff, H. & Winblad, U. (2018). When do people choose to be informed? Predictors of information-seeking in the choice of primary care provider in Sweden. Health Economics, Policy and Law
Open this publication in new window or tab >>When do people choose to be informed? Predictors of information-seeking in the choice of primary care provider in Sweden
2018 (English)In: Health Economics, Policy and Law, ISSN 1744-1331, E-ISSN 1744-134XArticle in journal (Refereed) Epub ahead of print
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-357158 (URN)10.1017/S1744133118000373 (DOI)
Available from: 2018-08-13 Created: 2018-08-13 Last updated: 2018-08-13
Winblad, U., Mor, V., McHugh, J. P. & Rahman, M. (2017). ACO-Affiliated Hospitals Reduced Rehospitalizations From Skilled Nursing Facilities Faster Than Other Hospitals. Health Affairs, 36(1), 67-73
Open this publication in new window or tab >>ACO-Affiliated Hospitals Reduced Rehospitalizations From Skilled Nursing Facilities Faster Than Other Hospitals
2017 (English)In: Health Affairs, ISSN 0278-2715, E-ISSN 1544-5208, Vol. 36, no 1, p. 67-73Article in journal (Refereed) Published
Abstract [en]

Medicare's more than 420 accountable care organizations (ACOs) provide care for a considerable percentage of the elderly in the United States. One goal of ACOs is to improve care coordination and thereby decrease rates of rehospitalization. We examined whether ACO-affiliated hospitals were more effective than other hospitals in reducing rehospitalizations from skilled nursing facilities. We found a general reduction in rehospitalizations from 2007 to 2013, which suggests that all hospitals made efforts to reduce rehospitalizations. The ACO-affiliated hospitals, however, were able to reduce rehospitalizations more quickly than other hospitals. The reductions suggest that ACO-affiliated hospitals are either discharging to the nursing facilities more effectively compared to other hospitals or targeting at-risk patients better, or enhancing information sharing and communication between hospitals and skilled nursing facilities. Policy makers expect that reducing readmissions to hospitals will generate major savings and improve the quality of life for the frail elderly. However, further work is needed to investigate the precise mechanisms that underlie the reduction of readmissions among ACO-affiliated hospitals.

Place, publisher, year, edition, pages
PROJECT HOPE, 2017
National Category
Health Sciences
Identifiers
urn:nbn:se:uu:diva-319305 (URN)10.1377/hlthaff.2016.0759 (DOI)000396336500009 ()28069848 (PubMedID)
Available from: 2017-04-18 Created: 2017-04-18 Last updated: 2017-04-25
Fredriksson, M., Halford, C., Eldh, A. C., Dahlström, T., Vengberg, S., Wallin, L. & Winblad, U. (2017). Are data from national quality registries used in quality improvement at Swedish hospital clinics?. International Journal for Quality in Health Care, 29(7), 909-915
Open this publication in new window or tab >>Are data from national quality registries used in quality improvement at Swedish hospital clinics?
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2017 (English)In: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 29, no 7, p. 909-915Article in journal (Refereed) Published
Abstract [en]

To investigate the use of data from national quality registries (NQRs) in local quality improvement as well as purported key factors for effective clinical use in Sweden. Comparative descriptive: a web survey of all Swedish hospitals participating in three NQRs with different levels of development (certification level). Heads of the clinics and physician(s) at clinics participating in the Swedish Stroke Register (Riksstroke), the Swedish National Registry of Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks) and the Swedish Lung Cancer Registry (NLCR). Individual and unit level use of NQRs in local quality improvement, and perceptions on data quality, organizational conditions and user motivation. Riksstroke data were reported as most extensively used at individual and unit levels ((x) over bar 17.97 of 24 and (x) over bar 27.06 of 35). Data quality and usefulness was considered high for the two most developed NQRs ((x) over bar 19.86 for Riksstroke and (x) over bar 19.89 for GallRiks of 25). Organizational conditions were estimated at the same level for Riksstroke and GallRiks ((x) over bar 12.90 and (x) over bar 13.28 of 20) while the least developed registry, the NLCR, had lower estimates (x<overline> 10.32). In Riksstroke, the managers requested registry data more often ((x) over bar 15.17 of 20). While there were significant differences between registries in key factors such as management interest, use of NQR data in local quality improvement seems rather prevalent, at least for Riksstroke. The link between the registry's level of development and factors important for routinization of innovations such as NQRs needs investigation.

Place, publisher, year, edition, pages
Oxford University Press, 2017
Keywords
quality improvement < quality management, audit < external quality assessment, hospital care < setting of care, practice variations < appropriate healthcare, care pathways, disease management < appropriate healthcare, cardiovascular diseases < disease categories, cancers < disease categories, endocrine disorders, incl, diabetes < disease categories
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-339702 (URN)10.1093/intqhc/mzx132 (DOI)000418713200005 ()29077930 (PubMedID)
Available from: 2018-01-26 Created: 2018-01-26 Last updated: 2018-01-26Bibliographically approved
von Granitz, H., Reine, I., Sonnander, K. & Winblad Spångberg, U. (2017). Do personal assistance activities promote participation for persons with disabilities in Sweden?. Disability and Rehabilitation, 39(24), 2512-2521
Open this publication in new window or tab >>Do personal assistance activities promote participation for persons with disabilities in Sweden?
2017 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 39, no 24, p. 2512-2521Article in journal (Refereed) Published
Abstract [en]

ABSTRACT

Purpose: To examine how the right to participation according to Article 19 of the United Nations’ Convention on the Rights of Persons with Disabilities (UNCRPD) is promoted by personal assistance use in Sweden across age, gender and eligible person categories.

Method: Register data and data from a questionnaire were used (N¼15,289). Principal component analysis was performed and the internal consistency was tested. Descriptive statistics (v2 test) were used across age, gender and eligible person categories and components.

Results: An uneven distribution of personal assistance across the components Health and Care; Home, Leisure and Social Interaction; and Daily Occupation was found. Significant differences in personal assistance reported were found between children and adults, men and women and between the three eligible person categories.

Conclusions: The discrepancy between reported and expected outcome of personal assistance indicates that Article 19 of the UNCRPD has not been met. The unequal access to participation across age, gender and eligible person categories would seem to further signify that the Act concerning Support and Service for Persons with Certain Functional Impairments is promoting activities of a caring nature rather than fulfilling Article 19 of the UNCRPD, i.e. ensuring full participation in society.

Keywords
CRPD, disability rights, independent living, social insurance, social policy
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-306679 (URN)10.1080/09638288.2016.1236405 (DOI)000410565300008 ()
Projects
Avhandlingsarbete; Att styra rättigheter rättsäkert: Har socialförsäkringens implementering av personlig assistans uppfyllt LSS värdegrund för goda levnadsvillkor?
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2012-0921
Available from: 2016-11-01 Created: 2016-11-01 Last updated: 2017-12-19Bibliographically approved
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