Logo: to the web site of Uppsala University

uu.sePublications from Uppsala University
Change search
Link to record
Permanent link

Direct link
Publications (10 of 42) Show all publications
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
Moberg, L., Fredriksson, M. & Leijon, K. (2023). Explaining variations in enforcement strategy: A comparison of the Swedish health care, eldercare, and compulsory school sector. Regulation and Governance, 17(4), 1041-1057
Open this publication in new window or tab >>Explaining variations in enforcement strategy: A comparison of the Swedish health care, eldercare, and compulsory school sector
2023 (English)In: Regulation and Governance, ISSN 1748-5983, E-ISSN 1748-5991, Vol. 17, no 4, p. 1041-1057Article in journal (Refereed) Published
Abstract [en]

This article analyzes whether, and if so, why, national inspectorates adopt different enforcement strategies when controlling the provision of welfare services, such as health care, eldercare, and the compulsory school. The findings show that the Swedish Schools Inspectorate uses a predominantly strict strategy, while the Health and Social Care Inspectorate relies on a more situational strategy. To explain this variation in enforcement strategy, the article tests four hypotheses derived from the literature on regulatory enforcement. The findings suggest that the variation between the agencies is not primarily the result of differences in resources or the authority to issue punitive decisions, as suggested by previous research. Instead, we find support for the hypothesis that the definition of quality can explain variation in adopted strategies, and partial support for the hypothesis that differences in regulatory mission can account for a variation in the agencies' formal enforcement strategies.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
Keywords
deductive content analysis, enforcement strategy, reactive governance, regulatory enforcement, social welfare services
National Category
Political Science (excluding Public Administration Studies and Globalisation Studies)
Research subject
Political Science
Identifiers
urn:nbn:se:uu:diva-486098 (URN)10.1111/rego.12499 (DOI)000862319100001 ()2-s2.0-85138995730 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2017-02164
Available from: 2022-10-02 Created: 2022-10-02 Last updated: 2023-12-08Bibliographically approved
Mattebo, M., Holmström, I. K., Höglund, A. T. & Fredriksson, M. (2023). Guideline documents on caesarean section on maternal request in Sweden: varying usability with a restrictive approach. BMC Health Services Research, 23(1), Article ID 1117.
Open this publication in new window or tab >>Guideline documents on caesarean section on maternal request in Sweden: varying usability with a restrictive approach
2023 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, no 1, article id 1117Article in journal (Refereed) Published
Abstract [en]

Background

Globally, studies illustrate different approaches among health care professionals to decision making about caesarean section (CS) and that attitudes regarding the extent to which a CS on maternal request (CSMR) can be granted vary significantly, both between professionals and countries. Absence of proper regulatory frameworks is one potential explanation for high CSMR rates in some countries, but overall, it is unclear how recommendations and guidelines on CSMR relate to CSMR rates. In Sweden, CSMR rates are low by international comparison, but statistics show that the extent to which maternity clinics perform CSMR vary among Sweden’s 21 self-governing regions. These regions are responsible for funding and delivery of healthcare, while national guidelines provide guidance for the professions throughout the country; however, they are not mandatory. To further understand considerations for CSMR requests and existing practice variations, the aim was to analyse guideline documents on CSMR at all local maternity clinics in Sweden.

Methods

All 43 maternity clinics in Sweden were contacted and asked for any guideline documents regarding CSMR. All clinics replied, enabling a total investigation. We used a combined deductive and inductive design, using the framework method for the analysis of qualitative data in multi-disciplinary health research.

Results

Overall, 32 maternity clinics reported guideline documents and 11 denied having any. Among those reporting no guideline documents, one referred to using national guideline document. Based on the Framework method, four theme categories were identified: CSMR is treated as a matter of fear of birth (FOB); How important factors are weighted in the decision-making is unclear; Birth contracts are offered in some regions; and The post-partum care is related to FOB rather than CSMR.

Conclusion

In order to offer women who request CS equal and just care, there is a pressing need to either implement current national guideline document at all maternity clinics or rewrite the guideline documents to enable clinics to adopt a structured approach. The emphasis must be placed on exploring the reasons behind the request and providing unbiased information and support. Our results contribute to the ongoing discussion about CSMR and lay a foundation for further research in which professionals, as well as stakeholders and both women planning pregnancy and pregnant women, can give their views on this issue.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Caesarean section on maternal request, CSMR, The framework method, Guidelines, Reproductive autonomy
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Obstetrics, Gynecology and Reproductive Medicine
Research subject
Health Care Research
Identifiers
urn:nbn:se:uu:diva-516147 (URN)10.1186/s12913-023-10077-7 (DOI)001095836500004 ()37853465 (PubMedID)
Funder
Mälardalen University
Available from: 2023-11-16 Created: 2023-11-16 Last updated: 2023-12-01Bibliographically approved
Fredriksson, M. & Modigh, A. (2023). Public involvement in the Swedish health system: citizen dialogues with unclear outcomes. BMC Health Services Research, 23(1), Article ID 947.
Open this publication in new window or tab >>Public involvement in the Swedish health system: citizen dialogues with unclear outcomes
2023 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, no 1, article id 947Article in journal (Refereed) Published
Abstract [en]

Background: In systems with representative democracy, there is a growing consensus that citizens should have the possibility to participate in decisions that affect them, extending beyond just voting in national or local/regional elections. However, significant uncertainty remains regarding the role of public involvement in decision-making, not least in healthcare. In this article, we focus on citizen dialogues (CDs) in a health system that is politically governed and decentralised. The aim of the study was to evaluate the functioning of citizen dialogues in the Swedish health system in terms of representation, process, content, and outcomes.

Methods: This study was conducted using a qualitative case design focusing on CDs at the regional level in Sweden. The regional level is politically elected and responsible for funding and provision of healthcare. The data consist of public documents describing and evaluating the CDs and interviews, which were analysed drawing on a modified version of the Abelson et al. analytical framework for evaluating public involvement in healthcare.

Results: Some CDs were an attempt to counteract political inequality by inviting groups that are less represented, while others aimed to increase legitimacy by reducing the distance between policymakers and citizens. The results from the CDs-which were often held in the beginning of a potential policy process-were often stated to be used as input in decision-making, but how was not made clear. Generally, the CDs formed an opportunity for members of the public to express preferences (on a broad topic) rather than developing preferences, with a risk of suggestions being too unspecific to be useful in decision-making. The more disinterested public perspective, in comparison with patients, reinforced the risk of triviality. A need for better follow-up on the impact of the CDs on actual decision-making was mentioned as a necessary step for progress.

Conclusions: It is unclear how input from CDs is used in policymaking in the politically governed regions responsible for healthcare in Sweden. The analysis points to policy input from CDs being too general and a lack of documentation of how it is used. We need to know more about how much weight input from CDs carry in relation to other types of information that politicians use, and in relation to other types of patient and public involvement.

Place, publisher, year, edition, pages
BMC, 2023
Keywords
Patient and public involvement, Citizen participation, Citizen dialogues, Swedish health system
National Category
Public Administration Studies
Identifiers
urn:nbn:se:uu:diva-512844 (URN)10.1186/s12913-023-09947-x (DOI)001059755000003 ()37667356 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2018-01578
Available from: 2023-10-02 Created: 2023-10-02 Last updated: 2023-10-02Bibliographically approved
Fredriksson, M. & Isaksson, D. (2022). Fifteen years with patient choice and free establishment in Swedish primary healthcare: what do we know?. Scandinavian Journal of Public Health, 50(7), 852-863, Article ID 14034948221095365.
Open this publication in new window or tab >>Fifteen years with patient choice and free establishment in Swedish primary healthcare: what do we know?
2022 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 50, no 7, p. 852-863, article id 14034948221095365Article in journal (Refereed) Published
Abstract [en]

Background: In 2007, a reform of Swedish primary healthcare began when some regions implemented enhanced patient choice in combination with free establishment for private providers. Although heavily debated, in 2010 it became mandatory for all regions to implement this choice system.

Aim: The aim of this article was to review all published research articles related to the primary healthcare choice reform in Sweden, to investigate what has been published about the reform and summarise its first 15 years.

Methods: A scoping review was performed to cover the breadth of research on the reform. Searches were made in Scopus, Web of Science and PubMed for articles published between 2007 and 2021, resulting in 217 unique articles. In total, 52 articles were included. Results: The articles were summarised and presented in relation to six overarching themes: arguments about the primary healthcare choice reform; governance and financial reimbursements; choice of provider and use of information; effects on equity and access; effects on quality; and differences between private and public primary healthcare centres.

Conclusions: The articles show that the reform has led to an increase in access to primary healthcare, but most studies indicate that the increase is inequitably distributed in terms of socioeconomy and geographical location. The effects on quality are unclear but several studies show that the mechanisms supposed to lead to quality improvements do not work as intended. Furthermore, from a population health perspective, it is time to discuss how such a responsibility can be reintegrated into primary healthcare and function with the choice system.

Place, publisher, year, edition, pages
Sage Publications, 2022
Keywords
Patient choice, scoping review, primary healthcare, primary care, any willing provider laws, choice of healthcare provider
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-492392 (URN)10.1177/14034948221095365 (DOI)000799802100001 ()35596549 (PubMedID)
Available from: 2023-01-04 Created: 2023-01-04 Last updated: 2023-01-04Bibliographically approved
Fredriksson, M. (2022). Patient and public involvement in the build-up of COVID-19 testing in Sweden. Health Expectations, 25(2), 541-548
Open this publication in new window or tab >>Patient and public involvement in the build-up of COVID-19 testing in Sweden
2022 (English)In: Health Expectations, ISSN 1369-6513, E-ISSN 1369-7625, Vol. 25, no 2, p. 541-548Article in journal (Refereed) Published
Abstract [en]

Background Patient and public involvement in healthcare can be particularly challenging during crises such as the COVID-19 pandemic. Objective The aims of the study, which focuses on COVID-19 testing in Sweden, were to explore (1) how, or to what extent, patients and members of the public were involved in decisions about the organization of COVID-19 testing during the first year of pandemic and (2) whether this was seen as feasible or desirable by regional and national stakeholders. Methods A qualitative interview study was conducted with key organizational stakeholders at three national agencies and within three Swedish regions (n = 16). Results There had been no patient and public involvement activities in the area of COVID-19 testing. The regions had, however, tried to respond to demands or critiques from patients and the public along the way and to adapt the services to respond to their preferences. The need for rapid decision-making, the uncertainty about whom to involve, as well as a hesitation about the appropriateness of involving patients and the public contributed to the lack of involvement. Conclusion Future studies on patient and public involvement during crises should address what structures need to be in place to carry out involvement successfully during crises and when to use activities with varying degrees of power or decision-making authority for patients and members of the public. Patient or Public Contribution Fifteen members of the public contributed with short reflections on the study findings.

Place, publisher, year, edition, pages
John Wiley & SonsWiley, 2022
Keywords
COVID-19 pandemic, COVID-19 testing, patient and public involvement, Sweden
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-483986 (URN)10.1111/hex.13463 (DOI)000765608700001 ()35257448 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2018-01578
Available from: 2022-09-06 Created: 2022-09-06 Last updated: 2024-01-15Bibliographically approved
Hallberg, A., Winblad, U. & Fredriksson, M. (2021). Balancing Pragmatism and Sustainability: A Case Study of an Interorganisational Network to Improve Integrated Care for the Elderly. International Journal of Integrated Care, 21(3)
Open this publication in new window or tab >>Balancing Pragmatism and Sustainability: A Case Study of an Interorganisational Network to Improve Integrated Care for the Elderly
2021 (English)In: International Journal of Integrated Care, E-ISSN 1568-4156, Vol. 21, no 3Article in journal (Refereed) Published
Abstract [en]

Introduction: Networks constitute a promising strategy for interorganisational collaboration, but may fail due to network tensions. By investigating the activities and internal dynamics of a voluntary meso-level network operating in the intersection of health and social care, this study aims to enhance the understanding of the relationship between pragmatism and sustainability and the role network governance plays in this respect.

Methods: In this descriptive case study, 2–3 researchers observed 3 three-hour long network meetings during the course of a year, and four complementary interviews were performed. Data were analysed based on the literature on network functioning and effectiveness.

Results: Pragmatism (a focus on ‘getting things done’) was more emphasised than sustainability although the network meetings also contained elements of relationship- and trust-building. The network leadership (a Network Administrative Organisation, NAO) created structure and concretized the participants’ ideas while remaining flexible and perceptive, and also carried out tasks which would otherwise not have been performed.

Discussion: The emphasis on pragmatism did not seem to influence sustainability negatively which has been pointed out as a potential risk in previous literature. Rather, the focus on pragmatism reinforced sustainability in a way that is similar to what has been described in prior research as a “trust-building loop” and discussed further in terms of a “perception of progress” mechanism. However, it was unclear what future the voluntary network would have without the NAO.

Conclusion: Network governance is instrumental to success, and should be carefully considered when initiating interorganisational network initiatives for integrated care.

Place, publisher, year, edition, pages
Ubiquity PressUbiquity Press, Ltd., 2021
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-463723 (URN)10.5334/ijic.5635 (DOI)000747123000004 ()34690618 (PubMedID)
Available from: 2022-01-11 Created: 2022-01-11 Last updated: 2024-01-15Bibliographically approved
Fredriksson, M. & Hallberg, A. (2021). COVID-19 Testing in Sweden During 2020 – Split Responsibilities and Multi-Level Challenges. Frontiers In Public Health, 9, Article ID 754861.
Open this publication in new window or tab >>COVID-19 Testing in Sweden During 2020 – Split Responsibilities and Multi-Level Challenges
2021 (English)In: Frontiers In Public Health, ISSN 2296-2565, Vol. 9, article id 754861Article in journal (Refereed) Published
Abstract [en]

Sweden's use of soft response measures early in the COVID-19 pandemic received a good deal of international attention. Within Sweden, one of the most debated aspects of the pandemic response has been COVID-19 testing and the time it took to increase testing capacity. In this article, the development of and the debate surrounding COVID-19 testing in Sweden during 2020 is described in detail, with a particular focus on the coordination between national and regional actors in the decentralised healthcare system. A qualitative case study was carried out based on qualitative document analysis with a chronological presentation. To understand COVID-19 testing in Sweden, two aspects of its public administration model emerged as particularly important: (i) the large and independent government agencies and (ii) self-governing regions and municipalities. In addition, the responsibility principle in Swedish crisis management was crucial. Overall, the results show that mass testing was a new area for coordination and involved a number of national and regional actors with partly different views on their respective roles, responsibilities and interpretations of the laws and regulations. The description shows the ambiguities in the purpose of testing and the shortcomings in communication and cooperation during the first half of 2020, but after that an increasing consistency among the crucial actors. During the first half of 2020, testing capacity in Sweden was limited and reserved to protect the most vulnerable in society. Because mass testing for viruses is not normally carried out by the 21 self-governing regions responsible for healthcare and communicable disease prevention, and the Public Health Agency of Sweden stated that there was no medical reason to test members of the public falling ill with COVID-like symptoms, the responsibility for mass testing fell through the cracks during the first few months of the pandemic. This article thus illustrates problems associated with multi-level governance in healthcare during a crisis and illustrates the discrepancy between the health service's focus on the individual and the public health-oriented work carried out within communicable disease control.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2021
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-463729 (URN)10.3389/fpubh.2021.754861 (DOI)000726597100001 ()34869171 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2018-01578
Available from: 2022-01-11 Created: 2022-01-11 Last updated: 2024-01-15Bibliographically approved
Gustafsson, I.-B., Winblad, U., Wallin, L. & Fredriksson, M. (2021). Factors that shape the successful implementation of decommissioning programmes: an interview study with clinic managers. BMC Health Services Research, 21(1), Article ID 805.
Open this publication in new window or tab >>Factors that shape the successful implementation of decommissioning programmes: an interview study with clinic managers
2021 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 21, no 1, article id 805Article in journal (Refereed) Published
Abstract [en]

Background As a response to many years of repetitive budget deficits, Region Dalarna in Sweden started a restructuring process in 2015, and implemented a decommissioning programme to achieve a balanced budget until 2019. Leading politicians and public servants took the overall decisions about the decommissioning programme, but the clinical decision-making and implementation was largely run by the clinic managers and their staff. As the decommissioning programme improved the finances, met relatively little resistance from the clinical departments, and neither patient safety nor quality of care were perceived to be negatively affected, the initial implementation could be considered successful. The aim of this study was to investigate clinic managers' experience of important factors enabling the successful implementation of a decommissioning programme in a local healthcare organization. Methods Drawing on a framework of factors and processes that shape successful implementation of decommissioning decisions, this study highlights the most important factors that enabled the clinic managers to successfully implement the decommissioning programme. During 2018, an interview study was conducted with 26 clinic managers, strategically selected to represent psychiatry, primary care, surgery and medicine. A deductive content analysis was used to analyze the interviews. By applying a framework to the data, the most important factors were illuminated. Results The findings highlighted factors and processes crucial to implementing the decommissioning programme: 1) create a story to get a shared image of the rationale for change, 2) secure an executive leadership team represented by clinical champions, 3) involve clinic managers at an early stage to ensure a fair decision-making process, 4) base the decommissioning decisions on evidence, without compromising quality and patient safety, 5) prepare the organisation to handle a process characterised by tensions and strong emotions, 6) communicate demonstrable benefits, 7) pay attention to the need of cultural and behavioral change and 8) transparently evaluate the outcome of the process. Conclusions From these findings, we conclude that in order to successfully implement a decommissioning programme, clinic managers and healthcare professions must be given and take responsibility, for both the process and outcome.

Place, publisher, year, edition, pages
BioMed Central (BMC)Springer Nature, 2021
Keywords
Decommissioning, Leadership, Clinic manager, Healthcare professionals, Implementation, Local healthcare organisation
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-453491 (URN)10.1186/s12913-021-06815-4 (DOI)000685305600002 ()34384416 (PubMedID)
Funder
Region Dalarna, LD16/01194
Available from: 2021-09-17 Created: 2021-09-17 Last updated: 2024-01-15Bibliographically approved
Winblad, U., Swenning, A.-K., Modigh, A., Åhlfeldt, E., Hedström, G. & Fredriksson, M. (2021). Hur samordnas strukturomvandlingen av hälso- och sjukvården med behov av investeringar av vårdbyggnader?. In: Riksintressen i hälso- och sjukvården – stärkt statlig styrning för hållbar vårdinfrastruktur. SOU 2021:71: (pp. 331-366). Stockholm: Statens offentliga utredningar
Open this publication in new window or tab >>Hur samordnas strukturomvandlingen av hälso- och sjukvården med behov av investeringar av vårdbyggnader?
Show others...
2021 (Swedish)In: Riksintressen i hälso- och sjukvården – stärkt statlig styrning för hållbar vårdinfrastruktur. SOU 2021:71, Stockholm: Statens offentliga utredningar , 2021, p. 331-366Chapter in book (Other academic)
Place, publisher, year, edition, pages
Stockholm: Statens offentliga utredningar, 2021
National Category
Social Sciences Political Science
Identifiers
urn:nbn:se:uu:diva-465204 (URN)978-91-525-0196-2 (ISBN)
Available from: 2022-01-17 Created: 2022-01-17 Last updated: 2023-06-30Bibliographically approved
Projects
Making decisions in healthcare: policy and preferences in Sweden and the UK [2012-06634_VR]; Uppsala UniversityHealth system governance through patient and public involvement: What is the impact? [2018-01578_Forte]; Uppsala University
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-3858-3454

Search in DiVA

Show all publications