umu.sePublications
Change search
Link to record
Permanent link

Direct link
BETA
Höög, Elisabet
Publications (10 of 15) Show all publications
Hansson, J., Höög, E. & Nyström, M. (2017). Action research for multi-level facilitation of improvement in health and social care: development of a change facilitation approach for a local R&D unit. Action Research, 15(4), 339-356
Open this publication in new window or tab >>Action research for multi-level facilitation of improvement in health and social care: development of a change facilitation approach for a local R&D unit
2017 (English)In: Action Research, ISSN 1476-7503, E-ISSN 1741-2617, Vol. 15, no 4, p. 339-356Article in journal (Refereed) Published
Abstract [en]

This paper reports an action research program designed to develop new approaches for a locally based Swedish R&D unit’s task to facilitate improvement in partner organizations, and to provide guidance on how to manage challenges in action research programs focusing on development in health and social care. Data were gathered from interviews with R&D members’, managers representing the two embedded pilot cases, as well as from the lead action researchers. Key findings were the need to continually monitor and revise the action research plan and that each step should be given specific weights based on the conditions at hand. As the action program evolved the participants were given autonomy to take action in the partner organizations and the role of the action researchers became advisory and consultative. These findings accentuate the emergent nature of action research and the need for flexible and dynamic intervention planning, especially when multiple level actors and several organizations are involved. Based on these findings we discuss some implications for the action researcher’s role and how similar programs can be designed to manage change in complex health and social care systems reaching various stakeholders at many levels.

Place, publisher, year, edition, pages
London: Sage Publications, 2017
Keywords
Action research, service improvement, change facilitation, health and social care
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-127193 (URN)10.1177/1476750316650928 (DOI)000417647000001 ()
Available from: 2016-11-02 Created: 2016-11-02 Last updated: 2018-06-09Bibliographically approved
Höög, E., Lysholm, J., Garvare, R., Weinehall, L. & Nystrom, M. E. (2016). Quality improvement in large healthcare organizations Searching for system-wide and coherent monitoring and follow-up strategies. Journal of Health Organisation & Management, 30(1), 133-153
Open this publication in new window or tab >>Quality improvement in large healthcare organizations Searching for system-wide and coherent monitoring and follow-up strategies
Show others...
2016 (English)In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 30, no 1, p. 133-153Article in journal (Refereed) Published
Abstract [en]

Purpose - The purpose of this paper is to investigate the obstacles and challenges associated with organizational monitoring and follow-up (M&F) processes related to health care quality improvement (QI) and development. Design/methodology/approach - A longitudinal case study of a large health care organization during a system-wide QI intervention. Content analysis was conducted of repeated interviews with key actors and archival data collected over a period of four years. Findings - The demand for improved M&F strategies, and what and how to monitor were described by the respondents. Obstacles and challenges for achieving M&F strategies that enables system-wide and coherent development were found in three areas: monitoring, processing, and feedback and communication. Also overarching challenges were found. Practical implications - A model of important aspects of M&F systems is presented that can be used for analysis and planning and contribute to shared cognition of such systems. Approaches for systematic analysis and follow-up of identified problems have to be developed and fully incorporated in the organization's measurement systems. A systematic M&F needs analytic and process-oriented competence, and this study highlights the potential in an organizational function with capacity and mandate for such tasks. Originality/value - Most health care systems are flooded with a vast amount of registers, records, and measurements. A key issue is how such data can be processed and refined to reflect the needs and the development process of the health care system and how rich data can be used for improvement purposes. This study presents key organizational actor's view on important factors to consider when building a coherent organizational M&F strategy.

Keywords
Change management, Quality improvement, Organizational development, Monitoring and follow-up
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-120369 (URN)10.1108/JHOM-10-2013-0209 (DOI)000374156600008 ()26964854 (PubMedID)
Available from: 2016-05-16 Created: 2016-05-16 Last updated: 2018-06-07Bibliographically approved
Westerlund, A., Garvare, R., Höög, E. & Nyström, M. (2015). Facilitating system-wide organizational change in health care. International Journal of Quality and Service Sciences, 7(1), 72-89
Open this publication in new window or tab >>Facilitating system-wide organizational change in health care
2015 (English)In: International Journal of Quality and Service Sciences, ISSN 1756-669X, E-ISSN 1756-6703, Vol. 7, no 1, p. 72-89Article in journal (Refereed) Published
Abstract [en]

Purpose: The purpose of this paper was to investigate the role of an intra-organizational change facilitating function (CFF) in relation to a multi-level development initiative in a health care organization. Involved actors’ views on factors in need of attention and how the CFF related to these factors were studied.

Design/methodology/approach: A longitudinal case study design was used, combining data from questionnaires, process diaries and interviews with employees at the CFF, managers and clinic staff.

Findings: Factors on micro, meso and macro levels, crucial to attend to, were highlighted by respondents at staff and managerial levels. The CFF related to some of these factors by acting upon them, or by developing plans to handle them, while other factors were unattended to. The CFF activities also had indirect influence on other factors. The CFF role and responsibilities were not clearly defined beforehand, and a need to clarify a division of roles and responsibilities is highlighted.

Research limitations/implications: Our study contributes to current knowledge on facilitation of change by relating it to an organizational dimension of implementation.

Practical implications: The description of important factors to handle during a large organizational change process and issues a CFF can encounter may aid others involved in designing and managing large organizational development initiatives.

Originality/value:The study elaborates on less studied functions and roles of an intra-organizational CFF in relation to factors of vital importance for organizational change and development in health-care organizations.

Place, publisher, year, edition, pages
Emerald Group Publishing Limited, 2015
Keywords
change management, health care, organizational development, quality improvement, change facilitation
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-112796 (URN)10.1108/IJQSS-01-2015-0004 (DOI)
Available from: 2015-12-14 Created: 2015-12-14 Last updated: 2018-06-07Bibliographically approved
Monica, N., Strehlenert, H. & Höög, E. (2014). Bättre liv för sjuka och äldre: Lärdomar från en nationell satsnings upplägg och arbetssätt för att stödja förändring. Stockholm: Institutionen för Lärande, Informatik, Management och Etik (LIME) Medical Management Centre Karolinska Institutet
Open this publication in new window or tab >>Bättre liv för sjuka och äldre: Lärdomar från en nationell satsnings upplägg och arbetssätt för att stödja förändring
2014 (Swedish)Report (Other academic)
Place, publisher, year, edition, pages
Stockholm: Institutionen för Lärande, Informatik, Management och Etik (LIME) Medical Management Centre Karolinska Institutet, 2014. p. 48
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-112800 (URN)
Projects
ett forskningsprojekt som under perioden 2012-2014 följt den nationella satsningen Bättre liv för sjuka äldre i Sverige
Available from: 2015-12-15 Created: 2015-12-15 Last updated: 2018-06-07Bibliographically approved
Nyström, M., Höög, E., Andersson Bäck, M., Garvare, R. & Hansson, J. (2014). Framtidens välfärdstjänster: Nya arbetssätt för innovativ serviceutveckling inom vård och omsorg.
Open this publication in new window or tab >>Framtidens välfärdstjänster: Nya arbetssätt för innovativ serviceutveckling inom vård och omsorg
Show others...
2014 (Swedish)Report (Other academic)
Alternative title[en]
Future wellfare services : New approaches to innovative service development in health and social care
Abstract [en]

En växande andel äldre i befolkningen i kombination med en minskande andel arbetskraft ställer allt tuffare krav på utveckling av vård och omsorg. För att klara dessa utmaningar och utveckla framtidens välfärdtjänster krävs nya innovativa arbetssätt. Vi arbetar nu med ett projekt som handlar om verksamhets- och serviceutveckling inom området äldre och vuxna med funktionsnedsättning. Projektet drivs i samarbete med ett tvärvetenskapligt forskarteam från Karolinska institutet, Göteborgs universitet och Luleå tekniska universitet och pågår från november 2009 till och med december 2012.

Syftet med projektet är att i regionen Sörmland utveckla och testa arbetssätt som kan stödja innovativ verksamhets- och serviceutveckling inom området äldre och vuxna med funktionsnedsättning. Projektet involverar flera organisatoriska nivåer och huvudmän, inklusive landsting och kommuner.   Den teoretiska basen bygger på lärdomar från kvalitetsutveckling, organisatoriskt lärande, innovationsforskning och organisatorisk kreativitet. Upplägget ger förutsättningar för lärande och snabb återkoppling över organisatoriska gränser. Resultaten kan bidra till kunskap om hur olika förutsättningar påverkar lärande, kreativitet och innovationsutveckling inom vård och omsorg, vilket i sin tur underlättar beslut kring strategiska satsningar och ökad kvalitet i vården. Projektet förväntas ge ny kunskap kring organisationers lärandeprocess som kan användas även för andra utvecklingssatsningar.

Publisher
p. ?
Series
Forskningsrapport Vinnovaprojektet 2009-01729
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-94726 (URN)
Projects
Vinnovaprojektet 2009-01729
Available from: 2014-10-15 Created: 2014-10-15 Last updated: 2018-06-07Bibliographically approved
Weinehall, L., Nyström, M., Garvare, R., Johansson, H., Kardakis, T., Sundberg, L., . . . Nyström, B. (2014). Nationella Riktlinjer för vårdens hälsofrämjande arbete: utmaningen att gå från evidens till klinisk tillämpning. Slutrapport från Vinnvårdsprojekt A2008-025. Umeå: Umeå universitet
Open this publication in new window or tab >>Nationella Riktlinjer för vårdens hälsofrämjande arbete: utmaningen att gå från evidens till klinisk tillämpning. Slutrapport från Vinnvårdsprojekt A2008-025
Show others...
2014 (Swedish)Report (Other academic)
Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2014. p. 37
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-112801 (URN)
Projects
Nationella Riktlinjer för vårdens hälsofrämjande arbete – Utmaningen att gå från evidens till klinisk tillämpning
Available from: 2015-12-15 Created: 2015-12-15 Last updated: 2018-06-07Bibliographically approved
Höög, E. (2014). Navigera i ständig förändring: facilitering av utvecklingsarbete inom vård och omsorg. (Doctoral dissertation). Umeå: Umeå universitet
Open this publication in new window or tab >>Navigera i ständig förändring: facilitering av utvecklingsarbete inom vård och omsorg
2014 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [sv]

Bakgrund Vård och omsorg arbetar under höga krav på kvalitet och säkerhet i sin verksamhet. Många förbättringsområden är kända, och nya tillkommer hela tiden. Vårdens och omsorgens organisationer arbetar hårt för att möta de utmaningar, krav och möjligheter de ställs inför. Många metoder och förslag på lösningar finns att tillgå, men det har visat sig svårt att med säkerhet veta vad som fungerar, och i vilket sammanhang. Kanske är frågorna om hur och varför någonting fungerar, eller ej, ännu viktigare att söka svar på. Avhandlingen riktar sitt fokus mot facilitering av förändring och utvecklingsarbete i vårdens och omsorgens organisationer. Omfattande forskning finns kring stöd och facilitering av utvecklings- och förbättringsarbete för små grupper, främst i kärnverksamheten. Forskning om systemövergripande och organiserad facilitering av utvecklingsarbete är inte lika vanligt förekommande. Genom att i min avhandling följa tre fall, där faciliterande grupperingar var aktiva under pågående systemövergripande ansatser för utveckling och förändring, önskar jag att jag kan bidra till ökad kunskap om utmaningar för och potentialen i att skapa förutsättningar för sådana faciliterande funktioner.

Metoder Avhandlingen bygger på fyra studier från tre empiriska fall. I samtliga fall studerades faciliterande grupperingar med uppdrag att stödja systemövergripande utvecklingsarbete i en geografisk region med många aktörer, organisationer och verksamheter, enheter, avdelningar och beslutsnivåer. De flesta av respondenterna tillhörde någon av de faciliterande grupperingarna, men data samlades också in från andra nyckelaktörer, aktiva i utvecklingsarbete. Datainsamlingen omfattade semistrukturerade intervjuer, processdagböcker, observationer och dokument. Avhandlingen bygger på innehållsanalys av kvalitativa data. Den innehållsanalys som tillämpats innefattar en systematisk och replikerbar teknik för att innehållskategorisera stora mängder data genom att tillämpa fasta definitioner och regler för kategorisering. För att stärka validiteten tillämpades triangulering av data från flera källor. För ökad reliabilitet har flera bedömare oberoende analyserat samma data när så varit möjligt.

Resultat Analysen av data från de tre fallen visar på stora utmaningar, men också lovande utsikter för stöd till förändring och utvecklingsarbete i vård och omsorg med hjälp av faciliterande grupperingar. Resultaten kan sammanfattas i fyra perspektiv: de faciliterande grupperingarnas interna relationer, roller och arbete; relationen mellan de faciliterande grupperingarna och de organisationer och verksamheter de arbetade med; förutsättningarna som skapades för facilitering inom organisationerna; och utvecklingen av faciliterande funktioner med kapacitet att fungerar som ett stöd för det uppdrag som organisationen har att utföra.

Slutsatser För att leda och stödja ett uthålligt förändrings- och utvecklingsarbete inom vård och omsorg behövs solid och mångfacetterad information och kunskap, förståelse för många typer av processer, och en flexibilitet som gör det möjligt att arbeta i ständig förändring och i en verklighet som uppvisar stor variation. Det förefaller finnas en stor potential i att använda faciliterande grupperingar med uppdrag att stödja utvecklingsarbete. För att kunna nyttja potentialen i sådana funktioner krävs kapacitet både inom grupperingarna och inom organisationen. Att bygga kapacitet för en fungerande faciliterande funktion omfattar både internt arbete i den faciliterande grupperingen och arbete på alla nivåer i organisationen. Något som omfattar planering, genomförande och uppföljningssystem där det dagliga arbetet och arbetet med att utveckla är sammanvävt och systematiskt. Det är idag oklart var nödvändig analys och reflektion kring utvecklingsarbete i ett systemövergripande perspektiv sker. Faciliterande grupperingar skulle kunna utgöra navet för en sådan kontinuerlig process om de äger kapacitet, mandat och förtroende att fylla den funktionen.

Abstract [en]

Background Health care and social services are complex entities, operating under high demands of quality and safety. There are many areas for development and new findings on what can be improved are presented continuously. To meet these demands and options organizations engage in efforts to change and develop what they do, and how they do it. Many interventions and methods are at hand, but it has proven difficult to answer the question of what works where and when. It is also stressed that an even more important question is how and why things work, or do not work. This thesis is focused on the facilitation of organizational development and quality improvement efforts. While a lot of research is found on the facilitation of improvement work in smaller workgroups, there is less on the more strategic and system-wide facilitation of organizational development and quality improvement. By following the facilitation of change and development work in three cases I aim to generate knowledge on the challenges in and the potential of using facilitation teams.

Methods The thesis is based on four studies from three empirical cases. In all case settings, the teams had the task of facilitating system-wide organizational development and quality improvement, covering geographical regions with several actors, organizations, units and decision levels. Key respondents where the facilitation team members, and data was also collected from other key actors involved in development efforts. Data collection included semi structured interviews, process diaries with defined areas for reflection, observations and archival data such as minutes, information sheets, presentations, annual reports and project reports. Qualitative data was analysed using content analysis, which is “a systematic, replicable technique for compressing many words of text into fewer content categories based on explicit rules of coding”. The two keystones for the type of content analysis used are the clear definitions of categories and mutually exclusive and exhaustive categories. Validity is strengthened by triangulation of data from multiple sources and reliability, when possible, by independent classification of data by two researchers.

Results Data from the three empirical cases show patterns of challenges as well as common promising prospects for facilitation of change and development in health care and social services. Challenges were identified within the formal and informal aspects of facilitation teams, in composition and organizational positions of facilitating teams, and in their understanding of premises, change and development processes. Results also revealed important factors influencing the possibilities to apply a facilitating approach that would be sustainable, serving the perspectives of a multi-level organization and building capacity for continuous development and improvement in the organisations, as well as within the facilitating teams.

Conclusion Sustainable change and development work in health care and social services organizations must be built on solid and multifaceted information, great understanding of processes in a broad sense and an ability to function in continuous change. There seems to be a great potential in having teams function with a role and mandate to facilitate organizational development and quality improvement processes through capacity building. This capacity building involves the facilitating team, the staff and management of the organization, and the forms and structures of planning, and implementation and follow-up systems where daily work and improvement efforts are interlinked. It is unclear where analysis and reflection on development work and improvement processes are carried out in health care and social services organizations today. Facilitating teams could be the hub of such an ongoing process, provided that they have the capacity, mandate and trust to fullfill such a function.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2014. p. 61
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1639
Keywords
Organisationsutveckling, organisationsförändring, förändringsarbete, utvecklingsarbete, facilitering, uppföljning
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-87916 (URN)978-91-7601-032-7 (ISBN)
Public defence
2014-05-09, Hörsal Betula, Unod L, plan 0, Byggnad 6M, Norrlands universitetssjukhus, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Projects
På väg mot uthållighet i innovationer och organisatoriskt lärande inom vårdenFramtidens välfärdstjänsterNationella riktlinjer för vårdens hälsofrämjande arbeteSFO-Vård
Available from: 2014-04-16 Created: 2014-04-14 Last updated: 2018-06-08Bibliographically approved
Höög, E., Garvare, R., Ivarsson, A., Weinehall, L. & Nyström, M. (2013). Challenges in managing a multi-sectoral health promotion program. Leadership in Health Services, 26(4), 368-386
Open this publication in new window or tab >>Challenges in managing a multi-sectoral health promotion program
Show others...
2013 (English)In: Leadership in Health Services, ISSN 1751-1879, E-ISSN 1751-1887, Vol. 26, no 4, p. 368-386Article in journal (Refereed) Published
Abstract [en]

Purpose: The purpose of this paper is to investigate program management teams’ views on issuesand challenges in managing a large, multi-sectoral child health promotion program in Sweden.

Design/methodology/approach: In total, 17 participants representing two autonomous programmanagement teams, one strategic and one operational, were interviewed. Analysis of interview datawas complemented with reviews of program documents.

Findings: Program management teams identified important issues concerning the program’sformal structure, goals, role distribution, and change and dissemination processes, but lacked a sharedmental model of the situation. Inter and intra group communication, long- and short-term strategicplanning were further areas in need of improvement. While issues and challenges might seem to beagreed upon by the program’s change agents, closer inspection reveals variation in key characteristicsas well as in perspectives on solutions.

Originality/value: Health promotion programs are challenging. Researchers trying tounderstand program success have focused on particular interventions, contextual factors andprogram recipients. Less research has focused on the internal processes of teams tasked withwide-ranging change mandates and the effects such processes can have on program outcomes. Thisstudy contributes to a deeper understanding on internal processes and mental models of changeagent teams.

Place, publisher, year, edition, pages
Emerald Group Publishing Limited, 2013
Keywords
health promotion, Sweden, mental models, change management, implementation process, program management
National Category
Health Sciences
Identifiers
urn:nbn:se:umu:diva-85029 (URN)10.1108/LHS-12-2011-0048 (DOI)
Available from: 2014-01-27 Created: 2014-01-27 Last updated: 2018-06-08Bibliographically approved
Nyström, M. E., Höög, E., Garvare, R., Weinehall, L. & Ivarsson, A. (2013). Change and learning strategies in large scale change programs: describing the variation of strategies used in a health promotion program. Journal of Organizational Change Management, 26(6), 1020-1044
Open this publication in new window or tab >>Change and learning strategies in large scale change programs: describing the variation of strategies used in a health promotion program
Show others...
2013 (English)In: Journal of Organizational Change Management, ISSN 0953-4814, E-ISSN 1758-7816, Vol. 26, no 6, p. 1020-1044Article in journal (Refereed) Published
Abstract [en]

Purpose The study identifies the variation of change strategies used in a complex large scale change program in health and social services in Sweden, aimed at changing professionals' health promoting practices. The purpose is to investigate the change strategies used over time and describe the potential variation in key change agent views, using a framework inspired by De Caluwe and Vermaak's multi paradigm change typology.

Design/methodology/approach The first six years of the regional multi-sector program are examined. Results are based on content analyses of interviews with key change actors, and archival data describing program activities. Respondents belonged to either the strategic or the operational program management team, representing different sectors of health and social services in a region.

Findings Multiple strategy paradigms showed varying influence over the program's different phases, partly due to program progress, change agent influence and/or varying contextual demands. Respondents' views on strategies and program focus varied depending on their program roles. Respondents expressed insights about the varying conditions for change and on the conflicting expectations within and between program management teams.

Originality/value This study introduces the application of a new framework on a large scale, complex change program. The framework sheds light on a number of basic assumptions and change strategies that can be further compared with content and context factors, barriers, facilitators, outcomes, and in turn with other programs.

Place, publisher, year, edition, pages
Emerald Group Publishing Limited, 2013
Keywords
Strategy, Change management, Organizational development, Organizational learning, Change agents, Large scale change programs, Sweden
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-83106 (URN)10.1108/JOCM-08-2012-0132 (DOI)000325783700006 ()
Available from: 2013-11-18 Created: 2013-11-18 Last updated: 2018-06-08Bibliographically approved
Nyström, M., Garvare, R., Ivarsson, A., Eurenius, E., Höög, E., Edvardsson, K., . . . Weinehall, L. (2013). På väg mot uthållighet i innovationer och organisatoriskt lärande inom vården: Slutrapport från Vinnvårdsprojekt A 2007034.
Open this publication in new window or tab >>På väg mot uthållighet i innovationer och organisatoriskt lärande inom vården: Slutrapport från Vinnvårdsprojekt A 2007034
Show others...
2013 (Swedish)Report (Other academic)
Identifiers
urn:nbn:se:umu:diva-64187 (URN)
Available from: 2013-01-18 Created: 2013-01-18 Last updated: 2018-06-08Bibliographically approved
Organisations

Search in DiVA

Show all publications