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  • 1.
    Anderzén, Ingrid
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Demmelmaier, Ingrid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Hansson, Ann-Sophie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Johansson, Per
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Economics. Uppsala University, Units outside the University, Office of Labour Market Policy Evaluation.
    Lindahl, Erica
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Economics. Uppsala University, Units outside the University, Office of Labour Market Policy Evaluation.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Samverkan i Resursteam: effekter på organisation, hälsa och sjukskrivning2008Report (Other academic)
    Abstract [sv]

    Vi utvärderar samverkansformen Resursteam, som bedrivits som ett försök för att minska långa sjukskrivningar. Resursteam innebär att ett team med hand-läggare från Försäkringskassan, husläkare, sjukgymnast och beteendevetare, vid regelbundna möten bedömer sjukskrivna personers rehabiliteringsbehov och ger förslag på åtgärder. Det övergripande syftet är att skatta effekten av Resursteam på den försäkrades sjukskrivningslängd och självskattade hälsa. Vi har genomfört (i) en kartläggning av verksamheten, (ii) en enkätstudie till sjuk-skrivna som deltagit i Resursteam och till jämförelsepersoner samt (ii) skattat effekten av Resursteam på självskattad hälsa och sjukskrivning. Resultaten är entydiga och visar på inga eller negativa effekter för de personer som ingått i Resursteam. Som exempel kan nämnas att tiden i sjukskrivning förlängs med cirka 20 procent i genomsnitt.

  • 2.
    Arnetz, Judith E.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Höglund, Anna T.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Arnetz, Bengt B.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Development and evaluation of a questionnaire for measuring patient views of involvement in myocardial infarction care2008In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 7, no 3, p. 229-238Article in journal (Refereed)
    Abstract [en]

    BACKGROUND

    Patients' involvement in their healthcare has been associated with improved treatment outcomes in chronic illness. Less is known about the affects of patient involvement on the outcomes of acute illness, such as myocardial infarction. A better understanding of patients' views and behaviour during hospitalization might improve clinical practice and enhance patient involvement.

    AIM

    The aim of this study was to develop and evaluate a questionnaire for measuring patients' perceptions of their involvement during hospitalization for myocardial infarction care.

    METHODS

    Focus groups with myocardial infarction patients provided the basis for the construction of the questionnaire. Questionnaire validity and reliability were evaluated in a small pilot study and a larger cross-sectional study among myocardial infarction patients at eleven Swedish hospitals.

    RESULTS

    The questionnaire demonstrated good validity and reliability, with six factors measuring patient views and behaviour regarding involvement.

    CONCLUSION

    The questionnaire appears to be a useful tool for evaluating the perceptions and behaviour of patients regarding patient involvement in myocardial infarction care. Use of this questionnaire may provide insight regarding areas of patient-staff interaction that need improvement. Pinpointing such areas may lead to improved patient involvement, satisfaction with care, and treatment outcomes.

  • 3.
    Arnetz, Judith E.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Höglund, Anna T.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Arnetz, Bengt B.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Staff views and behaviour regarding patient involvement in myocardial infarction care: development and evaluation of a questionnaire2008In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 7, no 1, p. 27-35Article in journal (Refereed)
    Abstract [en]

    BACKGROUND

    Healthcare legislation in several nations now dictates the responsibility of health care professionals to involve patients in decisions concerning care and treatment. However, few studies have examined the impact of patient involvement on the work of health care professionals. A better understanding of staff views and behaviour might enhance patient involvement.

    AIM

    The aim of this study was to develop and validate a questionnaire for measuring views and behaviour regarding patient involvement among physicians and nursing staff caring for patients with myocardial infarction.

    METHODS

    Focus groups among cardiology staff provided the basis for the construction of the questionnaire. Questionnaire validity and reliability were evaluated in a small pilot study and a larger cross-sectional study among cardiology staff at twelve Swedish hospitals.

    RESULTS

    The questionnaire demonstrated good validity and reliability, with two factors measuring staff views and four measuring behaviour.

    CONCLUSION

    The questionnaire appears to be a useful tool for evaluating the perceptions and behaviour of physicians and nursing staff regarding patient involvement in myocardial infarction care. Use of this questionnaire may provide insight regarding areas of staff-patient interaction that need improvement, as well as implications of patient involvement for the work of each professional group on cardiology wards.

  • 4.
    Arnetz, Judith E.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Arnetz, Bengt B.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Höglund, Anna T.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Physicians' and nurses' perceptions of patient involvement in myocardial infarction care2008In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 7, no 2, p. 113-120Article in journal (Refereed)
    Abstract [en]

    Background: Patients' involvement in their healthcare has been associated with better health outcomes. However, few studies have examined whether patient involvement affects the work of healthcare professionals. A better understanding of professionals' views and behaviour is necessary for improving clinical practice and optimizing patient involvement. Aim: To measure perceptions and behaviour regarding patient involvement among physicians and nursing staff caring for patients with acute myocardial infarction. Methods: A questionnaire study conducted in 2005 among cardiology staff at twelve Swedish hospitals. The questionnaire included six scales measuring staff views and behaviour. Results: Physicians, registered nurses, and practical nurses did not differ significantly in their views of patient involvement, but did differ significantly in behaviour (p<.001). All three groups felt that an actively involved patient enriched their work, at the same time increasing their work load and taking time from other tasks. Physicians discussed daily activities and lifestyle changes with myocardial infarction patients before hospital discharge to a greater extent than nursing staff (p<.001). Conclusion: Physicians and registered nurses viewed time constraints as a hinder for patient involvement, while practical nurses felt unsure in communicating with patients. Considering these organizational and professional issues may improve patient involvement and health outcomes in myocardial infarction care. (C) 2007 European Society of Cardiology. Published by Elsevier B.V All rights reserved.

  • 5.
    Arnetz, Judith E.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Höglund, Anna T.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Lindahl, Bertil
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , UCR-Uppsala Clinical Research Center.
    Spångberg, Kalle
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , UCR-Uppsala Clinical Research Center.
    Wallentin, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , UCR-Uppsala Clinical Research Center.
    Wang, Yun
    Ager, Joel
    Arnetz, Bengt B.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Is patient involvement during hospitalization for acute myocardial infarction associated with post-discharge treatment outcome?: an exploratory study2010In: Health Expectations, ISSN 1369-6513, E-ISSN 1369-7625, Vol. 13, no 3, p. 298-311Article in journal (Refereed)
    Abstract [en]

    Objective To investigate whether patient involvement during hospitalization for acute myocardial infarction (MI) was associated with health and behavioural outcomes 6–10 weeks after hospital discharge.

    Background Patient involvement has been associated with improved health outcomes in chronic disease, but less research has focused on the effects of patient involvement in acute conditions, such as MI.

    Design Self-administered questionnaire study. Questionnaire results were run against medical outcome data in a national database of cardiac patients.

    Setting and participants Cardiac patients (n = 591) on their first follow-up visit after hospitalization for MI at 11 Swedish hospitals.

    Main outcome measures Patient ratings of three questionnaire scales related to involvement; cardiovascular symptoms, medication compliance, participation in cardiac rehabilitation, and achievement of secondary preventive goals.

    Results More positive patient ratings of involvement were significantly associated with fewer cardiovascular symptoms 6–10 weeks after hospital discharge. In contrast, patients who attended cardiac rehabilitation and achieved the goals for smoking cessation and systolic blood pressure were significantly less satisfied with their involvement. No association was found between involvement ratings and medication compliance.

    Conclusion This study represents a first attempt to examine associations between patient involvement in the acute phase of illness and short-term health outcomes. Some significant associations between involvement and health and behavioural outcomes after acute MI were found. However, higher involvement ratings were not consistently associated with more desirable outcomes, and involvement during hospitalization was not associated with MI patient health and behaviour 6–10 weeks after hospital discharge to the extent hypothesized.

  • 6.
    Björkman, Annica
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Univ Gävle, Fac Hlth & Occupat Studies, Gävle, Sweden..
    Engström, Maria
    Univ Gävle, Fac Hlth & Occupat Studies, Gävle, Sweden..
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Holmström, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Mälardalen Univ, Sch Hlth Care & Social Welf, Västerås, Sweden..
    Malpractice claimed calls within the Swedish Healthcare Direct: a descriptive - comparative case study2021In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 20, article id 21Article in journal (Refereed)
    Abstract [en]

    Background: Medical errors are reported as a malpractice claim, and it is of uttermost importance to learn from the errors to enhance patient safety. The Swedish national telephone helpline SHD is staffed by registered nurses; its aim is to provide qualified healthcare advice for all residents of Sweden; it handles normally about 5 million calls annually. The ongoing Covid-19 pandemic have increased call volume with approximate 30%. The aim of the present study was twofold: to describe all malpractice claims and healthcare providers' reported measures regarding calls to Swedish Healthcare Direct (SHD) during the period January 2011-December 2018 and to compare these findings with results from a previous study covering the period January 2003-December 2010.

    Methods: The study used a descriptive, retrospective and comparative design. A total sample of all reported malpractice claims regarding calls to SHD (n = 35) made during the period 2011-2018 was retrieved. Data were analysed and compared with all reported medical errors during the period 2003-2010 (n = 33).

    Results: Telephone nurses' failure to follow the computerized decision support system (CDSS) (n = 18) was identified as the main reason for error during the period 2011-2018, while failure to listen to the caller (n = 12) was the main reason during the period 2003-2010. Staff education (n = 21) and listening to one's own calls (n = 16) were the most common measures taken within the organization during the period 2011-2018, compared to discussion in work groups (n = 13) during the period 2003-2010.

    Conclusion: The proportion of malpractice claims in relation to all patient contacts to SHD is still very low; it seems that only the most severe patient injuries are reported. The fact that telephone nurses' failure to follow the CDSS is the most common reason for error is notable, as SHD and healthcare organizations stress the importance of using the CDSS to enhance patient safety. The healthcare organizations seem to have adopted a more systematic approach to handling malpractice claims regarding calls, e.g., allowing telephone nurses to listen to their own calls instead of having discussions in work groups in response to events. This enables nurses to understand the latent factors contributing to error and provides a learning opportunity.

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  • 7.
    Blomqvist, Paula
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Government.
    Mankell, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Varför så få ideella aktörer inom äldreomsorgen?2014In: Välfärdsinsatser på religiös grund: förväntningar och problem / [ed] Anders Bäckström, Skellefteå: Artos & Norma Bokförlag , 2014Chapter in book (Refereed)
  • 8.
    Blomqvist, Paula
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Government.
    Winblad Spångberg, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Delrapport 1 i Samverkansprojektet äldreomsorg i förändring (SÄV): Äldreomsorgens historik i Sverige - från medeltid till början av 1990-tal2005Report (Other academic)
  • 9.
    Blomqvist, Paula
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Government.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Contracting out welfare services: how are private contractors held accountable?2022In: Public Management Review, ISSN 1471-9037, E-ISSN 1471-9045, Vol. 24, no 2, p. 233-254Article in journal (Refereed)
    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

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  • 10.
    Blomqvist, Paula
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Government.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Have the Welfare Professions Lost Autonomy?: A Comparative Study of Doctors and Teachers2024In: Journal of Social Policy, ISSN 0047-2794, E-ISSN 1469-7823, Vol. 53, no 1, p. 64-85Article in journal (Refereed)
    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.

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  • 11.
    Blomqvist, Paula
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Government.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Sweden2021In: Health Politics in Europe: A Handbook / [ed] Ellen M. Immergut, Karen M. Anderson, Camilla Devitt, & Tamara Popic, Oxford: Oxford University Press, 2021, p. 164-204Chapter in book (Refereed)
    Abstract [en]

    This chapter provides an extended look at health politics and the tax-financed, universal health system in Sweden. It traces the historical development of the Swedish healthcare system, characterized by a shifting relationship between a powerful, interventionist state and self-governing county-level governing institutions. Starting in the late 1980s, despite broad political agreement about the need to adapt the system and make it more patient-centered, there has been debate over most health reforms, particularly over the role of markets and private actors, with legislative votes largely following the left–right political party divide. Nevertheless, reforms like the introduction of private actors, mostly publicly financed and regulated, the enhancement of patient choice, measures to reduce waiting times, and other changes in the formerly nearly all-public system have taken place without seriously undermining the health system’s fundamentally solidaristic character.

  • 12.
    Blomqvist, Paula
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Government.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Sweden: Continued Marketization within a Universalist System2014In: Health Care Systems in Europe under Austerity: Institutional Reforms and Performance / [ed] Emmanuele Pavolini, Ana M. Guillén, Palgrave Macmillan , 2014, 1, p. 9-30Chapter in book (Refereed)
  • 13.
    Blomqvist, Paula
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Government.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Why No Nonprofits?: State, Market, and the Strive for Universalism in Swedish Elder Care2019In: Nonprofit and Voluntary Sector Quarterly, ISSN 0899-7640, E-ISSN 1552-7395, Vol. 48, no 3, p. 513-531Article in journal (Refereed)
    Abstract [en]

    Elder care is one of the sectors where nonprofit organizations are most active. One exception is the Scandinavian countries, where the nonprofit sector plays a marginal role in this area. In the article, we ask why this is the case. The findings show that in Sweden, nonprofit organizations have found it hard to compete with for-profits and that this inability to compete, in turn, reflects their relative organizational weakness. A main argument in the article is that this weakness must be understood in the context of the historical development of the modern elder care system in Sweden, where social democratic reformers in the 1940s chose to create a universal public system for providing services to the elderly, thereby making the nonprofit sector redundant. Universalism in this interpretation was seen as incompatible with service delivery by private organizations, a view that has come to change in recent years.

  • 14.
    Blomqvist, Paula
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Government.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Isaksson, David
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Analysis of contracts in Swedish elder care: can quality aspects be monitored? Arbetsrapport 2010:22010Other (Other (popular science, discussion, etc.))
  • 15.
    Borgquist, L.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Winblad, UlrikaUppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.Haglund, B.Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.Smedby, BjörnUppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Primärvård - vision och verklighet1995Conference proceedings (editor) (Other academic)
  • 16.
    Brantnell, Anders
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Psychology in Healthcare.
    Baraldi, Enrico
    Uppsala University, Disciplinary Domain of Science and Technology, Technology, Department of Engineering Sciences, Industrial Engineering & Management.
    van Achterberg, Theo
    KU Leuven.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Research funders’ roles and perceived responsibilities in relation to the implementation of clinical research results: a multiple case study of Swedish research funders2015In: Implementation Science, E-ISSN 1748-5908, Vol. 10, article id 100Article in journal (Refereed)
    Abstract [en]

    Background

    Implementation of clinical research results is challenging, yet the responsibility for implementation is seldom addressed. The process from research to the use of clinical research results in health care can be facilitated by research funders. In this paper, we report the roles of ten Swedish research funders in relation to implementation and their views on responsibilities in implementation.

    Findings

    Ten cases were studied and compared using semi-structured interviews. In addition, websites and key documents were reviewed. Eight facilitative roles for research funders in relation to the implementation of clinical research results were identified. Three of them were common for several funders: “Advocacy work,” “Monitoring implementation outcomes,” and “Dissemination of knowledge.” Moreover, the research funders identified six different actors responsible for implementation, five of which belonged to the healthcare setting. Collective and organizational responsibilities were the most common forms of responsibilities among the identified actors responsible for implementation.

    Conclusions

    The roles commonly identified by the Swedish funders, “Advocacy work,” “Monitoring implementation outcomes,” and “Dissemination of knowledge,” seem feasible facilitative roles in relation to the implementation of clinical research results. However, many actors identified as responsible for implementation together with the fact that collective and organizational responsibilities were the most common forms of responsibilities entail a risk of implementation becoming no one’s responsibility. 

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  • 17.
    Burström, Bo
    et al.
    Karolinska Inst, Dept Publ Hlth Sci, Equ & Hlth Policy Res Grp, SE-17177 Stockholm, Sweden..
    Burström, Kristina
    Karolinska Inst, Dept Publ Hlth Sci, Equ & Hlth Policy Res Grp, SE-17177 Stockholm, Sweden.;Karolinska Inst, Dept Learning Informat Management & Eth, Hlth Outcomes & Econ Evaluat Res Grp, Stockholm, Sweden..
    Nilsson, Gunnar
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden..
    Tomson, Göran
    Karolinska Inst, Dept Learning Informat Management & Eth, Stockholm, Sweden..
    Whitehead, Margaret
    Karolinska Inst, Dept Publ Hlth Sci, Equ & Hlth Policy Res Grp, SE-17177 Stockholm, Sweden.;Univ Liverpool, Inst Psychol Hlth & Soc, Dept Publ Hlth & Soc, Liverpool, Merseyside, England..
    Winbland, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Equity aspects of the Primary Health Care Choice Reform in Sweden - a scoping review2017In: International Journal for Equity in Health, E-ISSN 1475-9276, Vol. 16, article id 29Article in journal (Refereed)
    Abstract [en]

    Background: Good health and equal health care are the cornerstones of the Swedish Health and Medical Service Act. Recent studies show that the average level of health, measured as longevity, improves in Sweden, however, social inequalities in health remain a major issue. An important issue is how health care services can contribute to reducing inequalities in health, and the impact of a recent Primary Health Care (PHC) Choice Reform in this respect. This paper presents the findings of a review of the existing evidence on impacts of these reforms. Methods: We reviewed the published accounts (reports and scientific articles) which reported on the impact of the Swedish PHC Choice Reform of 2010 and changes in reimbursement systems, using Donabedian's framework for assessing quality of care in terms of structure, process and outcomes. Results: Since 2010, over 270 new private PHC practices operating for profit have been established throughout the country. One study found that the new establishments had primarily located in the largest cities and urban areas, in socioeconomically more advantaged populations. Another study, adjusting for socioeconomic composition found minor differences. The number of visits to PHC doctors has increased, more so among those with lesser needs of health care. The reform has had a negative impact on the provision of services for persons with complex needs. Opinions of doctors and staff in PHC are mixed, many state that persons with lesser needs are prioritized. Patient satisfaction is largely unchanged. The impact of PHC on population health may be reduced. Conclusions: The PHC Choice Reform increased the average number of visits, but particularly among those in more affluent groups and with lower health care needs, and has made integrated care for those with complex needs more difficult. Resource allocation to PHC has become more dependent on provider location, patient choice and demand, and less on need of care. On the available evidence, the PHC Choice Reform may have damaged equity of primary health care provision, contrary to the tenets of the Swedish Health and Medical Service Act. This situation needs to be carefully monitored.

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  • 18.
    Dahlberg, Matz
    et al.
    Uppsala universitet.
    Elinder, Mikael
    Uppsala universitet.
    Isaksson, David
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Jordahl, Henrik
    IFN.
    Lindbom, Anders
    Uppsala universitet.
    Lundqwist, Heléne
    Stockholms universitet.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Öhrvall, Richard
    Linköpings universitet.
    Slutsaster.2013In: Välfärdstjänster i privat regi.: Framväxt och drivkrafter. / [ed] Henrik Jordahl, Stockholm: SNS förlag , 2013, p. 221-230Chapter in book (Refereed)
  • 19.
    Egholm, Cecilie Lindström
    et al.
    Univ Southern Denmark, Ctr Rehabil & Palliat Care, Danish Knowledge Ctr Rehabil & Palliat Care, Odense, Denmark;Region Southern Denmark, Odense, Denmark;Holbaek Univ Hosp, Dept Med, Holbaek, Denmark.
    Helmark, Charlotte
    Zealand Univ Hosp, Dept Cardiol, Roskilde, Denmark.
    Christensen, Jan
    Copenhagen Univ Hosp, Rigshosp, Dept Occupat & Physiotherapy, Copenhagen, Denmark.
    Eldh, Ann Catrine
    Linkoping Univ, Dept Med & Hlth Sci, Linkoping, Sweden.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Bunkenborg, Gitte
    Holbaek Univ Hosp, Dept Anesthesiol, Holbaek, Denmark.
    Zwisler, Ann-Dorthe
    Univ Southern Denmark, Ctr Rehabil & Palliat Care, Danish Knowledge Ctr Rehabil & Palliat Care, Odense, Denmark.
    Nilsen, Per
    Linkoping Univ, Dept Med & Hlth Sci, Linkoping, Sweden.
    Facilitators for using data from a quality registry in local quality improvement work: a cross-sectional survey of the Danish Cardiac Rehabilitation Database2019In: BMJ Open, E-ISSN 2044-6055, Vol. 9, no 6, article id e028291Article in journal (Refereed)
    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.

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  • 20.
    Eldh, Ann Catrine
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. School of Education, Health, and Social Studies, Dalarna University, SE.
    Fredriksson, Mio
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Halford, Christina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Wallin, Lars
    School of Education, Health, and Social Studies, Dalarna University, SE.
    Dahlström, Tobias
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Vengberg, Sofie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Facilitators and barriers to applying a national quality registry for quality improvement in stroke care2014In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 14, p. 354-Article in journal (Refereed)
    Abstract [en]

    Background: National quality registries (NQRs) purportedly facilitate quality improvement, while neither the extent nor the mechanisms of such a relationship are fully known. The aim of this case study is to describe the experiences of local stakeholders to determine those elements that facilitate and hinder clinical quality improvement in relation to participation in a well-known and established NQR on stroke in Sweden. Methods: A strategic sample was drawn of 8 hospitals in 4 county councils, representing a variety of settings and outcomes according to the NQR's criteria. Semi-structured telephone interviews were conducted with 25 managers, physicians in charge of the Riks-Stroke, and registered nurses registering local data at the hospitals. Interviews, including aspects of barriers and facilitators within the NQR and the local context, were analysed with content analysis. Results: An NQR can provide vital aspects for facilitating evidence-based practice, for example, local data drawn from national guidelines which can be used for comparisons over time within the organisation or with other hospitals. Major effort is required to ensure that data entries are accurate and valid, and thus the trustworthiness of local data output competes with resources needed for everyday clinical stroke care and quality improvement initiatives. Local stakeholders with knowledge of and interest in both the medical area (in this case stroke) and quality improvement can apply the NQR data to effectively initiate, carry out, and evaluate quality improvement, if supported by managers and co-workers, a common stroke care process and an operational management system that embraces and engages with the NQR data. Conclusion: While quality registries are assumed to support adherence to evidence-based guidelines around the world, this study proposes that a NQR can facilitate improvement of care but neither the registry itself nor the reporting of data initiates quality improvement. Rather, the local and general evidence provided by the NQR must be considered relevant and must be applied in the local context. Further, the quality improvement process needs to be facilitated by stakeholders collaborating within and outside the context, who know how to initiate, perform, and evaluate quality improvement, and who have the resources to do so.

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  • 21.
    Eldh, Ann Catrine
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Fredriksson, Mio
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Vengberg, Sofie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Halford, Christina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Wallin, Lars
    Karolinska Institutet.
    Dahlström, Tobias
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Winblad, Ulrica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Depicting the interplay between organisational tiers in the use of a national quality registry to develop quality of care in Sweden2015In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 15, no 1, article id 519Article in journal (Refereed)
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  • 22.
    Eldh, Ann Catrine
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Dalarna Univ, Sch Hlth & Social Sci, Falun, Sweden..
    Wallin, Lars
    Dalarna Univ, Sch Hlth & Social Sci, Falun, Sweden.;Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Nursing, Stockholm, Sweden..
    Fredriksson, Mio
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Vengberg, Sofie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Halford, Christina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Dahlström, Tobias
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Factors facilitating a national quality registry to aid clinical quality improvement: findings of a national survey2016In: BMJ Open, E-ISSN 2044-6055, Vol. 6, no 11, article id e011562Article in journal (Refereed)
    Abstract [en]

    Objectives: While national quality registries (NQRs) are suggested to provide opportunities for systematic follow-up and learning opportunities, and thus clinical improvements, features in registries and contexts triggering such processes are not fully known. This study focuses on one of the world's largest stroke registries, the Swedish NQR Riksstroke, investigating what aspects of the registry and healthcare organisations facilitate or hinder the use of registry data in clinical quality improvement. Methods: Following particular qualitative studies, we performed a quantitative survey in an exploratory sequential design. The survey, including 50 items on context, processes and the registry, was sent to managers, physicians and nurses engaged in Riksstroke in all 72 Swedish stroke units. Altogether, 242 individuals were presented with the survey; 163 responded, representing all but two units. Data were analysed descriptively and through multiple linear regression. Results: A majority (88%) considered Riksstroke data to facilitate detection of stroke care improvement needs and acknowledged that their data motivated quality improvements (78%). The use of Riksstroke for quality improvement initiatives was associated (R-2=0.76) with 'Colleagues' call for local results' (p=<0.001), 'Management Request of Registry data' (p=<0.001), and it was said to be 'Simple to explain the results to colleagues' (p=0.02). Using stepwise regression, 'Colleagues' call for local results' was identified as the most influential factor. Yet, while 73% reported that managers request registry data, only 39% reported that their colleagues call for the unit's Riksstroke results. Conclusions: While an NQR like Riksstroke demonstrates improvement needs and motivates stakeholders to make progress, local stroke care staff and managers need to engage to keep the momentum going in terms of applying registry data when planning, performing and evaluating quality initiatives.

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  • 23.
    Eldh, Ann Catrine
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Patientdelaktighet -: dåtid, nutid och framtid2018In: Delaktighet och patientmedverkan / [ed] Ann Catrine Eldh, Lund: Studentlitteratur , 2018Chapter in book (Other academic)
  • 24.
    Ernesäter, Annica
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Engström, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Holmström, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Incident reporting within nurse-led national telephone triage in Sweden: reported errors reveal a pattern that needs to be broken2010In: Journal of Telemedicine and Telecare, ISSN 1357-633X, E-ISSN 1758-1109, Vol. 16, no 5, p. 243-247Article in journal (Refereed)
    Abstract [en]

    We conducted a retrospective study of incident reports concerning the national, nurse-led telephone triage system in Sweden. The Swedish Health Care Direct organization (SHD) is staffed by registered nurses who act as telenurses and triage the callers' need for care, using a computerized decision support system. Data were collected during 2007 from all county councils that participated in the SHD and were analysed using content analysis. Incident reports were then compared concerning differences in reported categories and who reported the errors. The 426 incident reports included 452 errors. Of the analysed incident reports, 41% concerned accessibility problems, 25% incorrect assessment, 15% routines/guidelines, 13% technical problems and 6% information and communication. The most frequent outgoing incident reports (i.e. sent from SHD to other health-care providers) concerned accessibility problems and the most frequently incoming reports (i.e. sent to SHD from other health-care providers) concerned incorrect assessment. There was a significant difference (P <  0.001) between outgoing and incoming reports regarding the main category. Telenurses have limited possibilities for referring the caller to their primary health-care provider or specialist, which may cause them to over-triage or under-triage the callers' need for care. This over-triage or under-triage may in turn cause other health-care providers to report incorrect assessment to SHD. The implications for practice are that poor accessibility is a matter that should be addressed and that the reasons for incorrect assessment should be explored.

  • 25.
    Ernesäter, Annica
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Engström, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Winblad Spångberg, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Rahmqvist, M
    Holmström, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Communication challenges in Swedish telephone advice nursing: analysis of actual calls2011Manuscript (preprint) (Other academic)
  • 26.
    Ernesäter, Annica
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Engström, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Gävle University.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Rahmqvist, Mikael
    Linköping University.
    Holmström, Inger K
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Telephone nurses’ communication and response to callers’ concern: a mixed methods study2016In: Applied Nursing Research, ISSN 0897-1897, E-ISSN 1532-8201, Vol. 23, p. 116-121Article in journal (Refereed)
    Abstract [en]

    Aims

    To describe telephone nurses’ and callers’ communication, investigate relationships within the dyad and explore telephone nurses’ direct response to callers’ expressions of concern

    Background

    Telephone nurses assessing callers’ need of care is a rapidly growing service. Callers with expectations regarding level of care are challenging.

    Method

    RIAS-and content analysis was performed on a criterion sampling of calls (n=25) made by callers who received a recommendation from telephone nurses of a lower level of care than expected.

    Results

    Telephone nurses mainly ask close-ended questions, whilst open-ended questions are sparsely used. Relationships between callers’ expressions of Concern and telephone nurses responding with Disapproval were found. Telephone nurses mainly responded to concern with close-ended medical questions whilst exploration of callers’ reason for concern was sparse.

    Conclusion

    Telephone nurses’ reluctance to use open-ended questions and to follow up on callers’ understanding might be a threat to concordance, and a potential threat to patient safety.

  • 27.
    Ernesäter, Annica
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Engström, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Winblad, Ulrika Spångberg
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Holmstrom, Inger Knutsson
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    A comparison of calls subjected to a malpractice claim versus 'normal calls' within the Swedish Healthcare Direct: a case-control study2014In: BMJ Open, E-ISSN 2044-6055, Vol. 4, no 10, p. e005961-Article in journal (Refereed)
    Abstract [en]

    Objectives: The purpose of this study is to compare communication patterns in calls subjected to a malpractice claim with matched controls. Setting: In many countries, telephone advice nursing is patients' first contact with healthcare. Telenurses' assessment of callers' symptoms and needs are based on verbal communication only, and problems with over-triage and under-triage have been reported. Participants: A total sample of all reported medical errors (n=33) during the period 2003-2010 within Swedish Healthcare Direct was retrieved. Corresponding calls were thereafter identified and collected as sound files from the manager in charge at the respective call centres. For technical reasons, calls from four of the cases were not possible to retrieve. For the present study, matched control calls (n=26) based on the patient's age, gender and main symptom presented by the caller were collected. Results: Male patients were in majority (n=16), and the most common reasons for calling were abdominal pain (n=10) and chest pain (n=5). There were statistically significant differences between the communication in the cases and controls: telenurses used fewer open-ended medical questions (p<0.001) in the cases compared to the control calls; callers provided telenurses with more medical information in the control calls compared to the cases (p=0.001); and telenurses used more facilitation and patient activation activities in the control calls (p=0.034), such as back-channel response (p=0.001), compared to the cases. Conclusions: The present study shows that telenurses in malpractice claimed calls used more closed-ended questioning compared to those in control calls, who used more open-ended questioning and back-channel response, which provided them with richer medical descriptions and more information from the caller. Hence, these communicative techniques are important in addition to solid medical and nursing competence and sound decision aid systems.

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  • 28.
    Ernesäter, Annica
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Engström, Maria
    Högskolan i Gävle.
    Holmström, Inger
    Örebro Universitet.
    Malpractice claims regarding calls to Swedish telephone advice nursing: what went wrong and why?2012In: Journal of Telemedicine and Telecare, ISSN 1357-633X, E-ISSN 1758-1109, Vol. 18, no 7, p. 379-383Article in journal (Refereed)
    Abstract [en]

    We analysed the characteristics of all malpractice claims arising out of telephone calls to Swedish Healthcare Direct (SHD) during 2003–2010 (n = 33). The National Board of Health and Welfare's (NBHW) investigations describing the causes of the malpractice claims and the healthcare providers' reported measures were analysed using Qualitative Content Analysis. The original telephone calls themselves, which had been recorded, were analysed using the Roter Interaction Analysis System (RIAS). Among the 33 cases, 13 patients died and 12 were admitted to intensive care. Failure to listen to the caller (n = 12) was the most common reason for malpractice claims, and work-group discussion (n = 13) was the most common measure taken to prevent future re-occurrence. Male patients (n = 19) were in the majority, and females (n = 24) were the most common callers. The most common symptoms were abdominal (n = 11) and chest pain (n = 6). Telenurses followed up on caller understanding in six calls, and mainly used closed-ended questions. Despite the severity of these malpractice claims, the measures taken mainly addressed active failure, rather than the latent conditions. Third-party communication should be regarded as a risk. When callers make repeated contacts, telenurses need to re-evaluate their need for care.

  • 29.
    Ewert, Benjamin
    et al.
    Fulda Univ Appl Sci, Dept Hlth Sci, Fulda, Germany..
    Wallenburg, Iris
    Erasmus Univ, Erasmus Sch Hlth Policy & Management, Rotterdam, Netherlands..
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Uppsala Univ, Dept Publ Hlth & Caring Sci, Uppsala, Sweden..
    Bal, Roland
    Erasmus Univ, Erasmus Sch Hlth Policy & Management, Rotterdam, Netherlands..
    Any lessons to learn?: Pathways and impasses towards health system resilience in post-pandemic times2023In: Health Economics, Policy and Law, ISSN 1744-1331, E-ISSN 1744-134X, Vol. 18, no 1, p. 66-81Article in journal (Refereed)
    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.

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  • 30.
    Fredriksson, Mio
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Blomqvist, Paula
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Government.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Conflict and Compliance in Swedish Health Care Governance: Soft Law in the ‘Shadow of Hierarchy’2012In: Scandinavian Political Studies, ISSN 0080-6757, E-ISSN 1467-9477, Vol. 35, no 1, p. 48-70Article in journal (Refereed)
    Abstract [en]

    Soft law, or non-legislative modes of policy making, is becoming increasingly common today. The Nordic countries have a long tradition soft law, not least in central–local relations, where non-binding agreements are frequently used to coordinate policies. A key question springing from soft law theory is that of compliance. Why do independent actors comply if they are not formally obliged to do so, and what happens if they do not comply? This article addresses the question of how compliance can be achieved during policy conflict between actors at different governing levels by investigating a case of health care reform in Sweden. An important finding in the study is that compliance was reached ‘in the shadow of hierarchy’. The central government resorted to the threat of regular legislation to force the county councils to comply. This finding points to the fact that sanctions and the presence of a hierarchical order may play an important role even in soft law governance. The study also shows that an additional important reason that the voluntary agreement between the county councils and central government was honoured in the end by both parties can be attributed to the efforts of a mediating actor: the organization representing the county councils in their negotiations with the government. Finally, the study also illustrates how various forms of informal social pressures such as shaming, peer pressure and moral responsibility can help enforce local compliance in a case of open policy conflict. Arguably, all these compliance mechanisms also have relevance outside the Nordic setting.

  • 31.
    Fredriksson, Mio
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Blomqvist, Paula
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Government.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    The trade-off between choice and equity: Swedish policymakers’ arguments when introducing patient choice2013In: Journal of European Social Policy, ISSN 0958-9287, E-ISSN 1461-7269, Vol. 23, no 2, p. 192-209Article in journal (Refereed)
    Abstract [en]

    How do policymakers deal with the tension between choice and equity in healthcare? An analysis and critical examination of Swedish policymakers' arguments when introducing legislated choice of primary care provider in 2010 shows that even when deciding on a reform with a potentially great impact on distribution of health resources, implications for equity were not systematically addressed. Effects with regards to current patterns of healthcare consumption in the population as well as existing inequalities in health outcomes were not adequately addressed. Neither was the primary are choice reform, which is based on the values of consumerism and individual choice, problematized in relation to current healthcare legislation such as the Health and Medical Services Act. Given that the values of equity and social solidarity have had such a prominent place in Swedish health policy and discourse in past decades, this is a surprising finding. In conclusion, we argue that because inequalities in health constitute one of the main challenges for public health today, the impact of healthcare reforms on equity should receive more attention in policymaking.

  • 32.
    Fredriksson, Mio
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Blomqvist, Paula
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Government.
    Winblad, Ulrika Spångberg
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Recentralizing healthcare through evidence-based guidelines – striving for national equity in Sweden2014In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 14, p. 509-Article in journal (Refereed)
    Abstract [en]

    Background: The Swedish government has increasingly begun to rely on so called informative governance when regulating healthcare. The question this article sets out to answer is: considered to be “the backbone” of the Swedish state’s strategy for informative governance in healthcare, what kind of regulatory arrangement is the evidence-based National Guidelines? Together with national medical registries and an extensive system of quality and efficiency indicators, the National Guidelines constitutes Sweden’s quality management system. Methods: A framework for evaluating and comparing regulatory arrangements was used. It asks for instance: what is the purpose of the regulation and are regulation methods oriented towards deterrence or compliance? Results: The Swedish National Guidelines is a regulatory arrangement intended to govern the prioritizations of alldecision makers – politicians and administrators in the self-governing county councils as well as healthcare professionals – through a compliance model backed up by top-down benchmarking and built-in mechanisms for monitoring. It is thus an instrument for the central state to steer local political authorities. The purpose is to achieve equitable and cost-effective healthcare. Conclusions: This article suggests that the use of evidence-based guidelines in Swedish healthcare should be seen in the light of Sweden’s constitutional setting, with several autonomous levels of political authority negotiating the scope for their decision-making power. As decision-making capacity is relocated to the central government – from the democratically elected county councils responsible for financing and provision of healthcare – the Swedish National Guidelines is part of an ongoing process of healthcare recentralization in Sweden, reducing the scope for local decision-making. This represents a new aspect of evidence-based medicine (EBM) and clinical practice guidelines (CPGs).

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  • 33.
    Fredriksson, Mio
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Eldh, Ann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Vengberg, Sofie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Dahlström, Tobias
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Halford, Christina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Wallin, Lars
    Högskolan Dalarna.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Local politico-administrative perspectives on quality improvement based on national registry data in Sweden: a qualitative study using the Consolidated Framework for Implementation Research2014In: Implementation Science, E-ISSN 1748-5908, Vol. 9, no 1, p. 189-Article in journal (Refereed)
    Abstract [en]

    Background: Through a national policy agreement, over 167 million Euros will be invested in the Swedish National Quality Registries (NQRs) between 2012 and 2016. One of the policy agreement¿s intentions is to increase the use of NQR data for quality improvement (QI). However, the evidence is fragmented as to how the use of medical registries and the like lead to quality improvement, and little is known about non-clinical use. The aim was therefore to investigate the perspectives of Swedish politicians and administrators on quality improvement based on national registry data.MethodsPoliticians and administrators from four county councils were interviewed. A qualitative content analysis guided by the Consolidated Framework for Implementation Research (CFIR) was performed.ResultsThe politicians¿ and administrators¿ perspectives on the use of NQR data for quality improvement were mainly assigned to three of the five CFIR domains. In the domain of intervention characteristics, data reliability and access in reasonable time were not considered entirely satisfactory, making it difficult for the politico-administrative leaderships to initiate, monitor, and support timely QI efforts. Still, politicians and administrators trusted the idea of using the NQRs as a base for quality improvement. In the domain of inner setting, the organizational structures were not sufficiently developed to utilize the advantages of the NQRs, and readiness for implementation appeared to be inadequate for two reasons. Firstly, the resources for data analysis and quality improvement were not considered sufficient at politico-administrative or clinical level. Secondly, deficiencies in leadership engagement at multiple levels were described and there was a lack of consensus on the politicians¿ role and level of involvement. Regarding the domain of outer setting, there was a lack of communication and cooperation between the county councils and the national NQR organizations.ConclusionsThe Swedish experiences show that a government-supported national system of well-funded, well-managed, and reputable national quality registries needs favorable local politico-administrative conditions to be used for quality improvement; such conditions are not yet in place according to local politicians and administrators.

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  • 34.
    Fredriksson, Mio
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Gustafsson, Inga-Britt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    A New Way of Thinking and Talking About Economy: Clinic Managers' Perspectives on the Sustainable Implementation of a Decommissioning Programme in Sweden2023In: HEALTH SERVICES INSIGHTS, ISSN 1178-6329, Vol. 16, article id 11786329231189402Article in journal (Refereed)
    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.

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  • 35.
    Fredriksson, Mio
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Gustafsson, Inga-Britt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Cuts without conflict: The use of political strategy in local health system retrenchment in Sweden2019In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 237, article id 112464Article in journal (Refereed)
    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.

  • 36.
    Fredriksson, Mio
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Halford, Christina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Eldh, Ann Catrine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Dahlström, Tobias
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Vengberg, Sofie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Wallin, Lars
    Dalarna Univ, Sch Educ Hlth & Social Studies, SE-79188 Falun, Sweden.;Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Nursing, Alfred Nobels Alle 23, SE-14183 Huddinge, Sweden.;Univ Gothenburg, Sahlgrenska Acad, Dept Hlth & Care Sci, Box 100, SE-40530 Gothenburg, Sweden..
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Are data from national quality registries used in quality improvement at Swedish hospital clinics?2017In: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 29, no 7, p. 909-915Article in journal (Refereed)
    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.

  • 37.
    Fredriksson, Mio
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Consequences of a decentralized healthcare governance model: measuring regional authority support for patient choice in Sweden2008In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 67, no 2, p. 271-279Article in journal (Refereed)
    Abstract [en]

    What are the implications of a decentralized model of healthcare governance? This case study on patient choice in Sweden is an attempt to shed light on this issue. Due to decentralization and constitutional rights of self-determination, the regional authorities in Sweden, called County Councils (CCs), have far-reaching rights to manage the healthcare sector. The fact that patient choice is considered to be a soft law or a soft governance regulation, opens it up to regional variation. To examine the CCs level of support of patient choice, an index is presented. The Patient Choice Index (PCI) shows that there is extensive variation among the CCs. To explain the causes of these variations, a number of hypotheses are tested. The analyses imply that ideology and economy, and more specifically the CCs' governing majorities and running net profits, are major explanations for the level of support. A number of conclusions can be drawn from the results of this study. In short, the CCs appear to act according to a local point of view, which means that there is no functioning national patient choice standard, and thus patients do not have equal access to healthcare and patients' rights are unevenly distributed. Furthermore, the CCs' financial conditions and governing majorities seem to undermine equivalent reform realization in a national context. In summary, the results of this study emphasize the conflict between regional self-governance and national equality, which is particularly visible in the decentralized Swedish healthcare model.

  • 38.
    Fredriksson, Mio
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Den privata vården: En ideologisk skiljelinje i svensk politik2009In: Mellan offentligt och privat: om styrning, praktik och intressen i hälso- och sjukvården / [ed] Kajsa Lindberg och Maria Blomgren, Stockholm: Santérus Academic Press , 2009, p. 35-50Chapter in book (Other academic)
  • 39.
    Gadbois, Emily A
    et al.
    Center for Gerontology and Healthcare Research Brown University School of Public Health Providence USA.
    Tyler, Denise A
    RTI International Research Triangle Park USA.
    Shield, Renee
    Center for Gerontology and Healthcare Research Brown University School of Public Health Providence USA.
    McHugh, John
    Mailman School of Public Health Columbia University New York USA.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Teno, Joan M
    Division of General Internal Medicine & Geriatrics Oregon Health Sciences University Portland USA.
    Mor, Vincent
    Center for Gerontology and Healthcare Research Brown University School of Public Health Providence USA.
    Lost in Transition: a Qualitative Study of Patients Discharged from Hospital to Skilled Nursing Facility2019In: Journal of general internal medicine, ISSN 0884-8734, E-ISSN 1525-1497, Vol. 34, no 1, p. 102-109Article in journal (Refereed)
    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.

  • 40.
    Gadbois, Emily A.
    et al.
    Brown Univ, Sch Publ Hlth, Ctr Gerontol & Healthcare Res, Providence, RI 02903 USA.
    Tyler, Denise A.
    RTI Int, Waltham, MA USA.
    Shield, Renee R.
    Brown Univ, Sch Publ Hlth, Ctr Gerontol & Healthcare Res, Providence, RI 02903 USA.
    McHugh, John P.
    Columbia Univ, Mailman Sch Publ Hlth, New York, NY USA.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Trivedi, Amal
    Brown Univ, Sch Publ Hlth, Ctr Gerontol & Healthcare Res, Providence, RI 02903 USA.
    Mor, Vincent
    Brown Univ, Sch Publ Hlth, Ctr Gerontol & Healthcare Res, Providence, RI 02903 USA;Providence Vet Affairs Med Ctr, Hlth Serv Res, Providence, RI USA.
    Medicare Advantage Control of Postacute Costs: Perspectives From Stakeholders2018In: American Journal of Managed Care, ISSN 1088-0224, E-ISSN 1936-2692, Vol. 24, no 12, p. E386-E392Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Medicare Advantage (MA) plans have strong incentives to control costs, including postacute spending; however, to our knowledge, no research has examined the methods that MA plans use to control or reduce postacute costs. This study aimed to understand such MA plan efforts and the possible unintended consequences. STUDY DESIGN: A multiple case study method was used. METHODS: We conducted 154 interviews with administrative and clinical staff working in 10 MA plans, 16 hospitals, and 25 skilled nursing facilities (SNFs) in 8 geographically diverse markets across the United States. RESULTS: Participants discussed how MA plans attempted to reduce postacute care spending by controlling the SNF to which patients are discharged and SNF length of stay (LOS). Plans typically influenced SNF selection by providing patients with a list of facilities in which their care would be covered. To influence LOS, MA plans most commonly authorized patient stays in SNFs for a certain number of days and required that SNFs adhere to this limitation, but they did not provide guidance or assistance in ensuring that the LOS goals were met. Hospital and SNF responses to the largely authorization-based system were frequently negative, and participants expressed concerns about potential unintended consequences. CONCLUSIONS: In their interactions with hospitals and SNFs, MA plans attempted to influence the choice of SNF and LOS to control postacute spending. However, exerting too much influence over hospitals and SNFs, as these results seem to indicate, may have the negative consequences of delayed hospital discharge and SNFs' avoidance of burdensome plans.

  • 41.
    Gofen, Anat
    et al.
    Hebrew Univ Jerusalem, Sch Publ Policy & Govt, Jerusalem, Israel.
    Blomqvist, Paula
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Government.
    Needham, Catherine E.
    Univ Birmingham, Hlth Serv Management Ctr, Birmingham, W Midlands, England.
    Warren, Kate
    Univ Birmingham, Hlth Serv Management Ctr, Birmingham, W Midlands, England.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Negotiated compliance at the street level: Personalizing immunization in England, Israel and Sweden2019In: Public Administration, ISSN 0033-3298, E-ISSN 1467-9299, Vol. 97, no 1, p. 195-209Article in journal (Refereed)
    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.

  • 42.
    Gray, Bradford H.
    et al.
    Urban Institute.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Sarnak, Dana O.
    The Commonwealth Fund.
    Sweden’s Esther Model: Improving Care for Elderly Patients with Complex Needs.2016Report (Other academic)
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  • 43.
    Gray, Bradford H.
    et al.
    Urban Institute.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Sarnak, Dana O.
    The Commonwealth Fund.
    Sweden’s Senior Alert Program: How an Information System Can Reduce Health Risks Among the Elderly2016Report (Other academic)
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  • 44.
    Gustafsson, Inga-Britt
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Dalarna Cty Council, Falun, Sweden.;Clin Res Ctr, Falun, Dalarna, Sweden.;Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden..
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Wallin, Lars
    Dalarna Cty Council, Falun, Sweden.;Clin Res Ctr, Falun, Dalarna, Sweden.;Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden..
    Fredriksson, Mio
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Factors that shape the successful implementation of decommissioning programmes: an interview study with clinic managers2021In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 21, no 1, article id 805Article in journal (Refereed)
    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.

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  • 45.
    Hallberg, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Fredriksson, Mio
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Balancing Pragmatism and Sustainability: A Case Study of an Interorganisational Network to Improve Integrated Care for the Elderly2021In: International Journal of Integrated Care, E-ISSN 1568-4156, Vol. 21, no 3Article in journal (Refereed)
    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.

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  • 46.
    Hallberg, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Fredriksson, Mio
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Vertical policy coordination of COVID-19 testing in Sweden: an analysis of policy-specific demands and institutional barriers2024In: Journal of Health Organization & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 38, no 9, p. 106-124Article in journal (Refereed)
    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.

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  • 47.
    Hanning, Marianne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Winblad Spångberg, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Köer och väntetider i sjukvården : det politiska perspektivet : intervjustudie med sjukvårdspolitiker i den södra sjukvårdsregionen våren 1997.1997Book (Other academic)
    Abstract [sv]

    Denna studie ingår i ett projekt där Landstingsförbundet, Samverkansnämndens kansli och sjukvårdshuvudmännen i den södra sjukvårdsregionen samarbetar för att ta fram ett förslag till uppföljningsmodell vad gäller köer och väntetider i sjukvården. Syftet med denna studie var att studera den landstingspolitiska nivåns uppfattning och upplevelse av köer och väntetider. I studien intervjuades sammanlagt 12 ledamöter i Södra samverkansnämnden. Intervjustudien visar att tillgänglighetsfrågor är mycket centrala i den lokala politiska debatten om sjukvården. Det var en allmän uppfattning att det inte enbart rör sig om resursbrist utan att det är fråga om komplicerade samband mellan många olika faktorer.

  • 48.
    Hanning, Marianne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Winblad Spångberg, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Maximum waiting time - a threat to clinical freedom?: Implementation of a policy to reduce waiting times2000In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 52, no 1, p. 15-32Article in journal (Refereed)
    Abstract [en]

    This article focuses on physicians as implementers of health policy reforms. In 1992, a maximum waiting-time guarantee was introduced in Sweden. Initially the policy was a successful way to come to terms with long waiting times. However, after 2 years the waiting lists started to increase. To understand this development it is important to look at the reactions to the policy among the implementers, i.e. the physicians. Three questions are addressed: Did the implementers understand the intentions and the goals of the reform? Were they able to fulfil the guarantee? And, did they approve of the initiative? The study subjects were chief physicians at the hospital departments involved with the guarantee. Their attitudes towards the policy were ascertained by two surveys. Other material, such as statistics on waiting times, was also used. The study shows that the physicians approved of the guarantee initially. The measures taken in the first years were effective and did not conflict with earlier practice. However, increased demand in combination with economic restraints necessitated new priorities among patient groups. These changes of clinical practice did not coincide with the physicians’ professional values and hence they became more critical to the initiative and finally chose to abandon the intentions in the guarantee.

  • 49.
    Hanning, Marianne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Winblad Spångberg, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Tillgänglighet och valfrihet1995In: Sjukvården i Sverige: 1995, En rapport om förhållanden inom hälso- och sjukvården, Stockholm: Socialstyrelsen , 1995, Vol. 25Chapter in book (Other academic)
  • 50.
    Hanning, Marianne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Vårdgarantins betydelse och effekter: en enkät till kliniker och sjukhus1994Report (Other (popular science, discussion, etc.))
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