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  • 1.
    Edvardsson, Kristina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Garvare, Rickard
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Eurenius, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Mogren, Ingrid
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Nyström, Monica E
    Medical Management Centre, Department of Learning, Informatics, Management & Ethics, Karolinska Institutet, Stockholm Sweden .
    Sustainable practice change. Professionals' experiences with a multisectoral child health promotion programme in Sweden.2011Ingår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 11, nr 1, s. 61-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: New methods for prevention and health promotion and are constantly evolving; however, positive outcomes will only emerge if these methods are fully adopted and sustainable in practice. To date, limited attention has been given to sustainability of health promotion efforts. This study aimed to explore facilitators, barriers, and requirements for sustainability as experienced by professionals two years after finalizing the development and implementation of a multisectoral child health promotion programme in Sweden (the Salut programme). Initiated in 2005, the programme uses a 'Salutogenesis' approach to support health-promoting activities in health care, social services, and schools.

    METHODS: All professionals involved in the Salut Programme's pilot areas were interviewed between May and September 2009, approximately two years after the intervention package was established and implemented. Participants (n=23) were midwives, child health nurses, dental hygienists/dental nurses, and pre-school teachers. Transcribed data underwent qualitative content analysis to illuminate perceived facilitators, barriers, and requirements for program sustainability.

    RESULTS: The programme was described as sustainable at most sites, except in child health care. The perception of facilitators, barriers, and requirements were largely shared across sectors. Facilitators included being actively involved in intervention development and small-scale testing, personal values corresponding to programme intentions, regular meetings, working close with collaborators, using manuals and a clear programme branding. Existing or potential barriers included insufficient managerial involvement and support and perceived constraints regarding time and resources. In dental health care, barriers also included conflicting incentives for performance. Many facilitators and barriers identified by participants also reflected their perceptions of more general and forthcoming requirements for program sustainability.

    CONCLUSIONS: These results contribute to the knowledge of processes involved in achieving sustainability in health promotion initiatives. Facilitating factors include involving front-line professionals in intervention development and using small scale testing; however, the success of a program requires paying attention to the role of managerial support and an overall supportive system. In summary, these results emphasise the importance for both practitioners and researchers to pay attention to parallel processes at different levels in multidisciplinary improvement efforts intended to ensure sustainable practice change.

  • 2.
    Edvardsson, Kristina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Eurenius, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Garvare, Rickard
    Nyström, Monica E
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Small, Rhonda
    Mogren, Ingrid
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Giving offspring a healthy start: parents' experiences of health promotion and lifestyle change during pregnancy and early parenthood2011Ingår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 11, s. 936-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: There are good opportunities in Sweden for health promotion targeting expectant parents and parents of young children, as almost all are reached by antenatal and child health care. In 2005, a multisectoral child health promotion programme (the Salut Programme) was launched to further strengthen such efforts.

    METHODS: Between June and December 2010 twenty-four in-depth interviews were conducted separately with first-time mothers and fathers when their child had reached 18 months of age. The aim was to explore their experiences of health promotion and lifestyle change during pregnancy and early parenthood. Qualitative manifest and latent content analysis was applied.

    RESULTS: Parents reported undertaking lifestyle changes to secure the health of the fetus during pregnancy, and in early parenthood to create a health-promoting environment for the child. Both women and men portrayed themselves as highly receptive to health messages regarding the effect of their lifestyle on fetal health, and they frequently mentioned risks related to tobacco and alcohol, as well as toxins and infectious agents in specific foods. However, health promotion strategies in pregnancy and early parenthood did not seem to influence parents to make lifestyle change primarily to promote their own health; a healthy lifestyle was simply perceived as 'common knowledge'. Although trust in health care was generally high, both women and men described some resistance to what they saw as preaching, or very directive counselling about healthy living and the lack of a holistic approach from health care providers. They also reported insufficient engagement with fathers in antenatal care and child health care.

    CONCLUSION: Perceptions about risks to the offspring's health appear to be the primary driving force for lifestyle change during pregnancy and early parenthood. However, as parents' motivation to prioritise their own health per se seems to be low during this period, future health promoting programmes need to take this into account. A more gender equal provision of health promotion to parents might increase men's involvement in lifestyle change. Furthermore, parents' ranking of major lifestyle risks to the fetus may not sufficiently reflect those that constitute greatest public health concern, an area for further study.

  • 3.
    Edvardsson, Kristina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Garvare, Rickard
    Eurenius, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lindkvist, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Statistik.
    Mogren, Ingrid
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Small, Rhonda
    Nyström, Monica E
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Improving child health promotion practices in multiple sectors: outcomes of the Swedish Salut Programme2012Ingår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 12, nr 1, s. 920-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: To improve health in the population, public health interventions must be successfully implemented within organisations, requiring behaviour change in health service providers as well as in the target population group. Such behavioural change is seldom easily achieved. The purpose of this study was to examine the outcomes of a child health promotion programme (The Salut Programme) on professionals' self-reported health promotion practices, and to investigate perceived facilitators and barriers for programme implementation.

    Methods: A before-and-after design was used to measure programme outcomes, and qualitative data on implementation facilitators and barriers were collected on two occasions during the implementation process. The sample included professionals in antenatal care, child health care, dental services and open pre-schools (n=144 pre-implementation) in 13 out of 15 municipalities in a Swedish county. Response rates ranged between 81% and 96% at the four measurement points.

    Results: Self-reported health promotion practices and collaboration were improved in all sectors at follow up. Significant changes included: 1) an increase in the extent to which midwives in antenatal care raised issues related to men's violence against women, 2) an increase in the extent to which several lifestyle topics were raised with parents/clients in child health care and dental services, 3) an increased use of motivational interviewing (MI) and separate 'fathers visits' in child health care 4) improvements in the supply of healthy snacks and beverages in open pre-schools and 5) increased collaboration between sectors. Main facilitators for programme implementation included cross-sectoral collaboration and sector-specific work manuals/questionnaires for use as support in everyday practice. Main barriers included high workload, and shortage of time and staff.

    Conclusion: This multisectoral programme for health promotion, based on sector-specific intervention packages developed and tested by end users, and introduced via interactive multisectoral seminars, shows potential for improving health promotion practices and collaboration across sectors. Consideration of the key facilitators and barriers for programme implementation as highlighted in this study can inform future improvement efforts.

  • 4. Garvare, Rickard
    et al.
    Westerlund, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Höög, Elisabet
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Nyström, Monica
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Health care improvement and learning : a study of emerging islands and system-wide approaches2011Konferensbidrag (Refereegranskat)
  • 5. Granström, Emma
    et al.
    Hansson, Johan
    Sparring, Vibeke
    Brommels, Mats
    Nyström, Monica E
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Enhancing policy implementation to improve healthcare practices: The role and strategies of hybrid national-local support structures2018Ingår i: International Journal of Health Planning and Management, ISSN 0749-6753, E-ISSN 1099-1751, Vol. 33, nr 4, s. E1262-E1278Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background In this study, we followed a national initiative to enhance the use of quality indicators gathered in national quality registries (NQRs) for improvement of clinical practices in Swedish healthcare, more specifically by investigating the support strategies of regional support centers with national and local missions. The aim was to increase knowledge on the role, challenges, and strategies of support structures with mixed and complex missions in the healthcare system. Methods Documents and 25 semistructured interviews with staff at 6 regional support centers, ie, quality registry centers, formed this multiple case study. Data were analyzed using conventional content analysis. Results The centers' strategies varied from developing the NQRs to become more suitable for improvement to supporting healthcare's use of NQRs, from the use of task to process-oriented support strategies, and from taking on national responsibilities to responding to local initiatives. All quality registry centers engaged in initiatives inspired by the Breakthrough Series approach. Some used preexisting change concepts or collaborated with local development units. A main challenge was to overcome a lack of formal mandate to act in the healthcare organizations they served. Conclusions Support functions with mixed and complex missions have to use a variation of strategies to reach relevant actors and achieve changes. This study provides valuable input for policy and decision-makers on the support strategies used and challenges of support functions with complex missions situated in-between national and local levels of the healthcare system, here denoted hybrid national-local support structures.

  • 6. Hansson, Johan
    et al.
    Höög, Elisabet
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Department of Learning Informatics Management and Ethics (LIME) and Medical Management Centre (MMC), Karolinska Institutet, Stockholm, Sweden.
    Nyström, Monica
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Department of Learning Informatics Management and Ethics (LIME) and Medical Management Centre (MMC), Karolinska Institutet, Stockholm, Sweden.
    Action research for multi-level facilitation of improvement in health and social care: development of a change facilitation approach for a local R&D unit2017Ingår i: Action Research, ISSN 1476-7503, E-ISSN 1741-2617, Vol. 15, nr 4, s. 339-356Artikel i tidskrift (Refereegranskat)
    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.

  • 7.
    Höög, Elisabet
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm.
    Garvare, Rickard
    Division of Quality Management, Luleå University of Technology, Luleå.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Nyström, Monica
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm.
    Challenges in managing a multi-sectoral health promotion program2013Ingår i: Leadership in Health Services, ISSN 1751-1879, E-ISSN 1751-1887, Vol. 26, nr 4, s. 368-386Artikel i tidskrift (Refereegranskat)
    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.

  • 8.
    Höög, Elisabet
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm.
    Hansson, Johan
    Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm.
    Garvare, Rickard
    Department of Business Administration, Technology and Social Sciences, Luleå University of Technology, Luleå.
    Andersson Bäck, Monica
    Department of Social work, Gothenburg University, Gothenburg and The Swedish Institute for Health Sciences, Lund University, Lund.
    Nyström, Monica E
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm.
    Building capacity for capacity building: Challenges in developing an R&D unit approachManuskript (preprint) (Övrigt vetenskapligt)
  • 9.
    Höög, Elisabet
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm.
    Hansson, Johan
    Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm.
    Garvare, Rickard
    Department of Business Administration, Technology and Social Sciences, Luleå University of Technology, Luleå.
    Andersson Bäck, Monica
    Department of Social work, Gothenburg University, Gothenburg and The Swedish Institute for Health Sciences, Lund University, Lund.
    Nyström, Monica E
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm.
    Building capacity for capacity building: challenges in developing an R&D unit approcachManuskript (preprint) (Övrigt vetenskapligt)
  • 10.
    Höög, Elisabet
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Lysholm, Jack
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Garvare, Rickard
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Nystrom, Monica Elisabeth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Quality improvement in large healthcare organizations Searching for system-wide and coherent monitoring and follow-up strategies2016Ingår i: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 30, nr 1, s. 133-153Artikel i tidskrift (Refereegranskat)
    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.

  • 11.
    Höög, Elisabet
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm.
    Lysholm, Jack
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Garvare, Rickard
    Division of Business Administration and Industrial Engineering, Luleå University of Technology, Luleå.
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Nyström, Monica Elisabeth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm.
    Quality improvement in large health care organizations: searching for system-wide and coherent monitoring and follow-up strategiesIngår i: Artikel i tidskrift (Övrigt vetenskapligt)
  • 12. Jönsson, K
    et al.
    Nyström, Monica
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Uzochukwu, BSC
    Okeyo, S
    Tomson, Göran
    Consortium for Health Policy and Systems Analysis in Africa: Strategy document for strengthening networking & capacity building for Getting Research into Policy & Practice (GRIPP): effective engagement for efficient resource mobilization and management supporting high quality health policy and systems research in Africa2012Rapport (Refereegranskat)
  • 13.
    Kardakis, Therese
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Jerdén, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Center for Clinical Research Dalarna, Falun, Sweden; School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Nyström, Monica E.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Johansson, Helene
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Implementation of clinical practice guidelines on lifestyle interventions in Swedish primary healthcare: a two-year follow up2018Ingår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 18, artikel-id 227Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Implementation of interventions concerning prevention and health promotion in health care has faced particular challenges resulting in a low frequency and quality of these services. In November 2011, the Swedish National Board of Health and Welfare released national clinical practice guidelines to counteract patients' unhealthy lifestyle habits. Drawing on the results of a previous study as a point of departure, the aim of this two-year follow up was to assess the progress of work with lifestyle interventions in primary healthcare as well as the uptake and usage of the new guidelines on lifestyle interventions in clinical practice. Methods: Longitudinal study among health professionals with survey at baseline and 2 years later. Development over time and differences between professional groups were calculated with Pearson chi-square test. Results: Eighteen percent of the physicians reported to use the clinical practice guidelines, compared to 58% of the nurses. Nurses were also more likely to consider them as a support in their work than physicians did. Over time, health professionals usage of methods to change patients' tobacco habits and hazardous use of alcohol had increased, and the nurses worked to a higher extent than before with all four lifestyles. Knowledge on methods for lifestyle change was generally high; however, there was room for improvement concerning methods on alcohol, unhealthy eating and counselling. Forty-one percent reported to possess thorough knowledge of counselling skills. Conclusions: Even if the uptake and usage of the CPGs on lifestyle interventions so far is low, the participants reported more frequent counselling on patients' lifestyle changes concerning use of tobacco and hazardous use of alcohol. However, these findings should be evaluated acknowledging the possibility of selection bias in favour of health promotion and lifestyle guidance, and the loss of one study site in the follow up. Furthermore, this study indicates important differences in physicians and nurses' attitudes to and use of the guidelines, where the nurses reported working to a higher extent with all four lifestyles compared to the first study. These findings suggest further investigations on the implementation process in clinical practice, and the physicians' uptake and use of the CPGs.

  • 14.
    Kardakis, Therese
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Jerdén, Lars
    Nyström, Monica
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Johansson, Helene
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Implementation of clinical guidelines on lifestyle in primary health care - a two-year follow upIngår i: Artikel i tidskrift (Refereegranskat)
  • 15.
    Kardakis, Therese
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Johansson, Helene
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Richter-Sundberg, Linda
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Garvare, Rickard
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Nyström, Monica
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Assessing context and intervention specific organisational readiness for change: Preparing primary healthcare for clinical practice guidelines on lifestyle interventionsManuskript (preprint) (Övrigt vetenskapligt)
  • 16.
    Kardakis, Therese
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Sundberg, Linda
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap.
    Nyström, Monica
    Medical Management Centre, Department of Learning, Informatics, Management & Ethics, Karolinska Institutet, Stockholm Sweden .
    Garvare, Rickard
    Luleå tekniska universitet.
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Utveckling och implementering av kliniska riktlinjer för hälso- och sjukvården: en litteraturöversikt2011Rapport (Refereegranskat)
    Abstract [en]

    Clinical practice guidelines are frequently developed to enhance quality in health care. However implementation is complex and often only partially completed. Our aim was to investigate and to analyze factors that are important to the development and implementation of clinical practice guidelines. We systematically searched for relevant papers in Pubmed. The results indicate that successful development of guidelines often is characterized by its use of multidisciplinary development groups and systematic literature review methods. Implementation of guidelines requires a planned multifaceted strategy based on analysis of organizational and individual readiness, as well as on the availability of necessary resources and a supportive leadership.

  • 17.
    Kardakis, Therese
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Jerdén, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Nyström, Monica E
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Johansson, Helene
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lifestyle interventions in primary health care: professional and organizational challenges2014Ingår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 24, nr 1, s. 79-84Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Interventions that support patient efforts at lifestyle changes that reduce tobacco use, hazardous use of alcohol, unhealthy eating habits and insufficient physical activity represent important areas of development for health care. Current research shows that it is challenging to reorient health care toward health promotion. The aim of this study was to explore the extent of health care professional work with lifestyle interventions in Swedish primary health care, and to describe professional knowledge, attitudes and perceived organizational support for lifestyle interventions.

    METHODS: The study is based on a cross-sectional Web-based survey directed at general practitioners, other physicians, residents, public health nurses and registered nurses (n = 315) in primary health care.

    RESULTS: Fifty-nine percent of the participants indicated that lifestyle interventions were a substantial part of their duties. A majority (77%) would like to work more with patient lifestyles. Health professionals generally reported a thorough knowledge of lifestyle intervention methods for disease prevention. Significant differences between professional groups were found with regard to specific knowledge and extent of work with lifestyle interventions. Alcohol was the least addressed lifestyle habit. Management was supportive, but structures to sustain work with lifestyle interventions were scarce, and a need for national guidelines was identified.

    CONCLUSIONS: Health professionals reported thorough knowledge and positive attitudes toward lifestyle interventions. When planning for further implementation of lifestyle interventions in primary health care, differences between professional groups in knowledge, extent of work with promotion of healthy lifestyles and lifestyle issues and provision of organizational support such as national guidelines should be considered.

  • 18. Luthander, Charlotte Millde
    et al.
    Kallen, Karin
    Nyström, Monica E.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Departmentof Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institute, Stockholm.
    Hogberg, Ulf
    Håkansson, Stellan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Harenstam, Karin P.
    Grunewald, Charlotta
    Results from the National Perinatal Patient Safety Program in Sweden: the challenge of evaluation2016Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 95, nr 5, s. 596-603Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: We studied the effects of the national Perinatal Patient Safety Program in Sweden, addressing local improvement measures, changes in the proportion of low Apgar score and the number of settled injury claims due to asphyxia.

    Material and methods: Final reports on achieved improvements from all Swedish obstetric units were analyzed and categories of the improvement measures taken in perinatal risk areas were established. Data on all term newborns during 2006–12 were obtained from the Medical Birth Registry. Incidence of 5-min Apgar score <7 was analyzed before, during and after the intervention. The odds ratio for low Apgar score in period ÍII vs. period I was calculated. Patient injury claims from The Swedish National Patient Insurance Company (LÖF) were analyzed.

    Results: Numerous local improvement initiatives were reported. The incidence of 5-min Apgar score <7 on a national level remained unchanged during the study periods. The units with the highest rate of Apgar score <7 showed a significant decrease in Apgar score of 4–6 after the intervention, whereas units with the lowest rate of Apgar score <7 showed a significant increase in Apgar score <7 after the intervention. A decline in settled claims due to substandard care was observed (7.5%, 2012–14; p for trend 0.049).

    Conclusion: The national incidence of low Apgar score remained unchanged but a reduction of settled claims of severely asphyxiated neonates was observed. The study highlights the need for robust designs when evaluating large-scale initiatives for improving patient safety at delivery, along with the difficulties in performing them.

  • 19. Mazzocato, Pamela
    et al.
    Stenfors-Hayes, Terese
    von Thiele Schwarz, Ulrica
    Hasson, Henna
    Nyström, Monica Elisabeth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Kaizen practice in healthcare: a qualitative analysis of hospital employees' suggestions for improvement2016Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, nr 7, artikel-id e012256Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: Kaizen, or continuous improvement, lies at the core of lean. Kaizen is implemented through practices that enable employees to propose ideas for improvement and solve problems. The aim of this study is to describe the types of issues and improvement suggestions that hospital employees feel empowered to address through kaizen practices in order to understand when and how kaizen is used in healthcare.

    METHODS: We analysed 186 structured kaizen documents containing improvement suggestions that were produced by 165 employees at a Swedish hospital. Directed content analysis was used to categorise the suggestions into following categories: type of situation (proactive or reactive) triggering an action; type of process addressed (technical/administrative, support and clinical); complexity level (simple or complex); and type of outcomes aimed for (operational or sociotechnical). Compliance to the kaizen template was calculated.

    RESULTS: 72% of the improvement suggestions were reactions to a perceived problem. Support, technical and administrative, and primary clinical processes were involved in 47%, 38% and 16% of the suggestions, respectively. The majority of the kaizen documents addressed simple situations and focused on operational outcomes. The degree of compliance to the kaizen template was high for several items concerning the identification of problems and the proposed solutions, and low for items related to the test and implementation of solutions.

    CONCLUSIONS: There is a need to combine kaizen practices with improvement and innovation practices that help staff and managers to address complex issues, such as the improvement of clinical care processes. The limited focus on sociotechnical aspects and the partial compliance to kaizen templates may indicate a limited understanding of the entire kaizen process and of how it relates to the overall organisational goals. This in turn can hamper the sustainability of kaizen practices and results.

  • 20. McAlearney, Ann Scheck
    et al.
    Terris, Darcey
    Hardacre, Jeanne
    Spurgeon, Peter
    Brown, Claire
    Baumgart, Andre
    Nyström, Monica E
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Organizational coherence in health care organizations: conceptual guidance to facilitate quality improvement and organizational change2014Ingår i: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 23, nr 4, s. 254-267Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: We sought to improve our understanding of how health care quality improvement (QI) methods and innovations could be efficiently and effectively translated between settings to reduce persistent gaps in health care quality both within and across countries. We aimed to examine whether we could identify a core set of organizational cultural attributes, independent of context and setting, which might be associated with success in implementing and sustaining QI systems in health care organizations. Methods: We convened an international group of investigators to explore the issues of organizational culture and QI in different health care contexts and settings. This group met in person 3 times and held a series of conference calls to discuss emerging ideas over 2 years. Investigators also conducted pilot studies in their home countries to examine the applicability of our conceptual model. Results and Conclusions: We suggest that organizational coherencemay be a critical element of QI efforts in health care organizations and propose that there are 3 key components of organizational coherence: (1) people, (2) processes, and (3) perspectives. Our work suggests that the concept of organizational coherence embraces both culture and context and can thus help guide both researchers and practitioners in efforts to enhance health care QI efforts, regardless of organizational type, location, or context.

  • 21. McAlearney, Ann Scheck
    et al.
    Terris, Darcey
    Hardacre, Jeanne
    Spurgeon, Peter
    Brown, Claire
    Baumgart, Andre
    Nyström, Monica E
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Organizational coherence in health care organizations: conceptual guidance to facilitate quality improvement and organizational change2013Ingår i: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 22, nr 2, s. 86-99Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: We sought to improve our understanding of how health care quality improvement (QI) methods and innovations could be efficiently and effectively translated between settings to reduce persistent gaps in health care quality both within and across countries. We aimed to examine whether we could identify a core set of organizational cultural attributes, independent of context and setting, which might be associated with success in implementing and sustaining QI systems in health care organizations.

    METHODS: We convened an international group of investigators to explore the issues of organizational culture and QI in different health care contexts and settings. This group met in person 3 times and held a series of conference calls to discuss emerging ideas over 2 years. Investigators also conducted pilot studies in their home countries to examine the applicability of our conceptual model.

    RESULTS AND CONCLUSIONS: We suggest that organizational coherence may be a critical element of QI efforts in health care organizations and propose that there are 3 key components of organizational coherence: (1) people, (2) processes, and (3) perspectives. Our work suggests that the concept of organizational coherence embraces both culture and context and can thus help guide both researchers and practitioners in efforts to enhance health care QI efforts, regardless of organizational type, location, or context.

  • 22. Millde-Luthander, C
    et al.
    Högberg, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Nyström, Monica E
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Pettersson, H
    Wiklund, I
    Grunewald, C
    The impact of a computer assisted learning programme on the ability to interpret cardiotochography. A before and after study2012Ingår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 3, nr 1, s. 37-41Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To evaluate if a computer assisted learning programme could bring about a higher degree of individuals who correctly classified cardiotochography (CTG) recordings in a non-selected population of midwives and physicians.

    Study design: A before and after study. Setting: Sodersjukhuset, Stockholm, Sweden.

    Subjects: One hundred and thirty midwives and 49 physicians at the maternity unit, September 2009-April 2010. A computer assisted learning programme for interpreting CTG patterns has been created. All 179 individuals included made the first interpretation and the 135 individuals also completing the education made the second interpretation. A third randomly selected interpretation was performed immediately following the second: permitting two participants to classify a CTG together. Comparison between the before and after-test was based on the Fisher exact test.

    Main Outcome measure: The proportion of individuals who correctly classified CTGs before and after the training.

    Results: Sixty four percentage of the individuals classified the CTGs correctly before and 66% after the training (P = 0.76). There was no difference between the two professional groups. Normal CTGs were correctly identified by 36% of the individuals before and in 80% after the training (P = 0.065). Corresponding figures for pathological CTGs were 83% and 85% (P = 1.00), respectively.

    Conclusion: We found no improvement in the proportion of individuals who classified CTGs correctly after the completion of a computer assisted learning programme in fetal monitoring. The baseline level of competence was higher than expected. (C) 2011 Elsevier B.V. All rights reserved.

  • 23.
    Monica, Nyström
    et al.
    Institutionen för lärande, informatik, management och etik, Karolinska institutet, Stockholm.
    Strehlenert, Helena
    Institutionen för lärande, informatik, management och etik, Karolinska institutet, Stockholm.
    Höög, Elisabet
    Institutionen för lärande, informatik, management och etik, Karolinska institutet, Stockholm.
    Bättre liv för sjuka och äldre: Lärdomar från en nationell satsnings upplägg och arbetssätt för att stödja förändring2014Rapport (Övrigt vetenskapligt)
  • 24.
    Nyström, Monica
    Medical Management Centre, Department of Learning,Informatics, Management & Ethics, Karolinska Institutet, Stockholm, Sweden.
    Characteristics of health care organizations associated with learning and development: lessons from a pilot study2009Ingår i: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 18, nr 4, s. 285-294Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Characteristics of health care organizationsassociated with an ability to learn from experiencesand to develop and manage change were exploredin this study. Understanding of these characteristicsis necessary to identify factors influencing successin learning from the past and achieving futurehealth care quality objectives. A literature review ofthe quality improvement, strategic organizationaldevelopment and change management,organizational learning, and microsystems fieldsidentified 20 organizational characteristics, groupedunder (a) organizational systems, (b) key actors, and(c) change management processes. Qualitativemethods, using interviews, focus group reports, andarchival records, were applied to find associationsbetween identified characteristics and 6 Swedishhealth care units externally evaluated as deliveringhigh-quality care. Strong support for a characteristicwas defined as units having more than 4 sourcesdescribing the characteristic as an importantsuccess factor. Eighteen characteristics had strongsupport from at least 2 units. The strongest evidencewas found for the following: (i) key actors havelong-term commitment, provide support, and makesense of ambiguous situations; (ii) organizationalsystems encourage employee commitment,participation, and involvement; and (iii) changemanagement processes are employedsystematically. Based on the results, a new model of“characteristics associated with learning anddevelopment in health care organizations” isproposed.

  • 25.
    Nyström, Monica
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Characteristics of health care organizations associated with learning and development: lessons from a pilot study2009Ingår i: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 18, nr 4, s. 285-294Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Characteristics of health care organizations associated with an ability to learn from experiences and to develop and manage change were explored in this study. Understanding of these characteristics is necessary to identify factors influencing success in learning from the past and achieving future health care quality objectives. A literature review of the quality improvement, strategic organizational development and change management, organizational learning, and microsystems fields identified 20 organizational characteristics, grouped under (a) organizational systems, (b) key actors, and (c) change management processes. Qualitative methods, using interviews, focus group reports, and archival records, were applied to find associations between identified characteristics and 6 Swedish health care units externally evaluated as delivering high-quality care. Strong support for a characteristic was defined as units having more than 4 sources describing the characteristic as an important success factor. Eighteen characteristics had strong support from at least 2 units. The strongest evidence was found for the following: (i) key actors have long-term commitment, provide support, and make sense of ambiguous situations; (ii) organizational systems encourage employee commitment, participation, and involvement; and (iii) change management processes are employed systematically. Based on the results, a new model of "characteristics associated with learning and development in health care organizations" is proposed.

  • 26.
    Nyström, Monica
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi. Medical Management Centre, Institutionen LIME, Karolinska Institutet.
    Chefsuppdragets komplexitet i politiskt styrda organisationer: utmaningar, hantering och utvecklingsmöjligheter2009Rapport (Refereegranskat)
  • 27.
    Nyström, Monica
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Utvecklings- och förbättringsarbete inom vården2007Rapport (Övrigt vetenskapligt)
  • 28.
    Nyström, Monica E
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet.
    Höög, Elisabet
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Garvare, R.
    Andersson Bäck, M.
    Terris, D. D.
    Hansson, J.
    Exploring the potential of a multi-level approach to improve capability for continuous organizational improvement and learning in a Swedish healthcare region2018Ingår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 18, artikel-id 376Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Eldercare and care of people with functional impairments is organized by the municipalities in Sweden. Improving care in these areas is complex, with multiple stakeholders and organizations. Appropriate strategies to develop capability for continuing organizational improvement and learning (COIL) are needed. The purpose of our study was to develop and pilot-test a flexible, multilevel approach for COIL capability building and to identify what it takes to achieve changes in key actors' approaches to COIL. The approach, named "Sustainable Improvement and Development through Strategic and Systematic Approaches" (SIDSSA), was applied through an action-research and action-learning intervention.

    METHODS: The SIDSSA approach was tested in a regional research and development (R&D) unit, and in two municipalities handling care of the elderly and people with functional impairments. Our approach included a multilevel strategy, development loops of five flexible phases, and an action-learning loop. The approach was designed to support systems understanding, strategic focus, methodological practices, and change process knowledge - all of which required double-loop learning. Multiple qualitative methods, i.e., repeated interviews, process diaries, and documents, provided data for conventional content analyses.

    RESULTS: The new approach was successfully tested on all cases and adopted and sustained by the R&D unit. Participants reported new insights and skills. The development loop facilitated a sense of coherence and control during uncertainty, improved planning and problem analysis, enhanced mapping of context and conditions, and supported problem-solving at both the individual and unit levels. The systems-level view and structured approach helped participants to explain, motivate, and implement change initiatives, especially after working more systematically with mapping, analyses, and goal setting.

    CONCLUSIONS: An easily understood and generalizable model internalized by key organizational actors is an important step before more complex development models can be implemented. SIDSSA facilitated individual and group learning through action-learning and supported systems-level views and structured approaches across multiple organizational levels. Active involvement of diverse organizational functions and levels in the learning process was facilitated. However, the time frame was too short to fully test all aspects of the approach, specifically in reaching beyond the involved managers to front-line staff and patients.

  • 29.
    Nyström, Monica E
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet.
    Karltun, J
    Keller, C
    Andersson Gäre, B
    Collaborative and partnership research for improvement of health and social services: researcher's experiences from 20 projects2018Ingår i: Health Research Policy and Systems, ISSN 1478-4505, E-ISSN 1478-4505, Vol. 16, artikel-id 46Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Getting research into policy and practice in healthcare is a recognised, world-wide concern. As an attempt to bridge the gap between research and practice, research funders are requesting more interdisciplinary and collaborative research, while actual experiences of such processes have been less studied. Accordingly, the purpose of this study was to gain more knowledge on the interdisciplinary, collaborative and partnership research process by investigating researchers' experiences of and approaches to the process, based on their participation in an inventive national research programme. The programme aimed to boost collaborative and partnership research and build learning structures, while improving ways to lead, manage and develop practices in Swedish health and social services.

    METHODS: Interviews conducted with project leaders and/or lead researchers and documentation from 20 projects were analysed using directed and conventional content analysis.

    RESULTS: Collaborative approaches were achieved by design, e.g. action research, or by involving practitioners from several levels of the healthcare system in various parts of the research process. The use of dual roles as researcher/clinician or practitioner/PhD student or the use of education designed especially for practitioners or 'student researchers' were other approaches. The collaborative process constituted the area for the main lessons learned as well as the main problems. Difficulties concerned handling complexity and conflicts between different expectations and demands in the practitioner's and researcher's contexts, and dealing with human resource issues and group interactions when forming collaborative and interdisciplinary research teams. The handling of such challenges required time, resources, knowledge, interactive learning and skilled project management.

    CONCLUSIONS: Collaborative approaches are important in the study of complex phenomena. Results from this study show that allocated time, arenas for interactions and skills in project management and communication are needed during research collaboration to ensure support and build trust and understanding with involved practitioners at several levels in the healthcare system. For researchers, dealing with this complexity takes time and energy from the scientific process. For practitioners, this puts demands on understanding a research process and how it fits with on-going organisational agendas and activities and allocating time. Some of the identified factors may be overlooked by funders and involved stakeholders when designing, performing and evaluating interdisciplinary, collaborative and partnership research.

  • 30.
    Nyström, Monica E
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Terris, Darcey D
    Sparring, Vibeke
    Tolf, Sara
    Brown, Claire R
    Perceived organizational problems in health care: a pilot test of the structured problem and success inventory2012Ingår i: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 21, nr 2, s. 93-103Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Our objective was to test whether the Structured Problem and Success Inventory (SPI) instrument could capture mental representations of organizational and work-related problems as described by individuals working in health care organizations and to test whether these representations varied according to organizational position. A convenience sample (n = 56) of middle managers (n = 20), lower-level managers (n = 20), and staff (n = 16) from health care organizations in Stockholm (Sweden) attending organizational development courses during 2003-2004 was recruited. Participants used the SPI to describe the 3 most pressing organizational and work-related problems. Data were systematically reviewed to identify problem categories and themes. One hundred sixty-four problems were described, clustered into 13 problem categories. Generally, middle managers focused on organizational factors and managerial responsibilities, whereas lower-level managers and staff focused on operational issues and what others did or ought to do. Furthermore, we observed similarities and variation in perceptions and their association with respondents' position within an organization. Our results support the need for further evaluation of the SPI as a promising tool for health care organizations. Collecting structured inventories of organizational and work-related problems from multiple perspectives may assist in the development of shared understandings of organizational challenges and lead to more effective and efficient processes of solution planning and implementation.

  • 31.
    Nyström, Monica E.
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Westerlund, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Höög, Elisabet
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Millde-Luthander, Charlotte
    Högberg, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Grunewald, Charlotta
    Healthcare system intervention for prevention of birth injuries: process evaluation of self-assessment, peer review, feedback and agreement for change2012Ingår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 12, artikel-id 274Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Patient safety is fundamental in high quality healthcare systems but despite an excellent record of perinatal care in Sweden some children still suffer from substandard care and unnecessary birth injuries. Sustainable patient safety improvements assume changes in key actors' mental models, norms and culture as well as in the tools, design and organisation of work. Interventions positively affecting team mental models on safety issues are a first step to enhancing change. Our purpose was to study a national intervention programme for the prevention of birth injuries with the aim to elucidate how the main interventions of self-assessment, peer review, feedback and written agreement for change affected the teams and their mental model of patient safety, and thereby their readiness for change. Knowledge of relevant considerations before implementing this type of patient safety intervention series could thereby be increased.

    Methods: Eighty participants in twenty-seven maternity units were interviewed after the first intervention sequence of the programme. A content analysis using a priori coding was performed in order to relate results to the anticipated outcomes of three basic interventions: self-assessment, peer review and written feedback, and agreement for change.

    Results: The self-assessment procedure was valuable and served as a useful tool for elucidating strengths and weaknesses and identifying areas for improvement for a safer delivery in maternity units. The peer-review intervention was appreciated, despite it being of less value when considering the contribution to explicit outcome effects (i.e. new input to team mental models and new suggestions for actions). The feedback report and the mutual agreement on measures for improvements reached when signing the contract seemed exert positive pressures for change.

    Conclusions: Our findings are in line with several studies stressing the importance of self-evaluation by encouraging a thorough review of objectives, practices and outcomes for the continuous improvement of an organisation. Even though effects of the peer review were limited, feedback from peers, or other change agents involved, and the support that a clear and well-structured action plan can provide are considered to be two important complements to future self-assessment procedures related to patient safety improvement.

  • 32.
    Nyström, Monica Elisabeth
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi. Karolinska institutet.
    Höög, Elisabet
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Karolinska institutet.
    Garvare, Rickard
    Luleå tekniska universitet.
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Change and learning strategies in large scale change programs: describing the variation of strategies used in a health promotion program2013Ingår i: Journal of Organizational Change Management, ISSN 0953-4814, E-ISSN 1758-7816, Vol. 26, nr 6, s. 1020-1044Artikel i tidskrift (Refereegranskat)
    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.

  • 33.
    Nyström, Monica Elisabeth
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE 171 77 Stockholm, Sweden.
    Strehlenert, Helena
    Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE 171 77 Stockholm, Sweden.
    Hansson, Johan
    Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE 171 77 Stockholm, Sweden.
    Hasson, Henna
    Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE 171 77 Stockholm, Sweden and Centre for Epidemiology and community medicine, Stockholm county council, SE 171 29 Stockholm, Sweden.
    Strategies to facilitate implementation and sustainability of large system transformations: a case study of a national program for improving quality of care for elderly people2014Ingår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 14, artikel-id 401Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Large-scale change initiatives stimulating change in several organizational systems in the health and social care sector are challenging both to lead and evaluate. There is a lack of systematic research that can enrich our understanding of strategies to facilitate large system transformations in this sector. The purpose of this study was to examine the characteristics of core activities and strategies to facilitate implementation and change of a national program aimed at improving life for the most ill elderly people in Sweden. The program outcomes were also addressed to assess the impact of these strategies.

    METHODS: A longitudinal case study design with multiple data collection methods was applied. Archival data (n = 795), interviews with key stakeholders (n = 11) and non-participant observations (n = 23) were analysed using content analysis. Outcome data was obtained from national quality registries.

    RESULTS: This study presents an approach for implementing a large national change program that is characterized by initial flexibility and dynamism regarding content and facilitation strategies and a growing complexity over time requiring more structure and coordination. The description of activities and strategies show that the program management team engaged a variety of stakeholders and actor groups and accordingly used a palate of different strategies. The main strategies used to influence change in the target organisations were to use regional improvement coaches, regional strategic management teams, national quality registries, financial incentives and annually revised agreements. Interactive learning sessions, intense communication, monitor and measurements, and active involvement of different experts and stakeholders, including elderly people, complemented these strategies. Program outcomes showed steady progress in most of the five target areas, less so for the target of achieving coordinated care.

    CONCLUSIONS: There is no blue-print on how to approach the challenging task of leading large scale change programs in complex contexts, but our conclusion is that more attention has to be given to the multidimensional strategies that program management need to consider. This multidimensionality comprises different strategies depending on types of actors, system levels, contextual factors, program progress over time, program content, types of learning and change processes, and the conditions for sustainability.

  • 34.
    Nyström, Monica
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Garvare, R
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Eurenius, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Höög, Elisabet
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Edvardsson, Kristina
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Westerlund, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Stening, L
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    På väg mot uthållighet i innovationer och organisatoriskt lärande inom vården: Slutrapport från Vinnvårdsprojekt A 20070342013Rapport (Övrigt vetenskapligt)
  • 35.
    Nyström, Monica
    et al.
    Karolinska Institutet, Medical Management Centre.
    Garvare, Rickard
    Westerlund, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Concurrent implementation of quality improvement programs. Coordination or conflict?2014Ingår i: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 27, nr 3, s. 190-208Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose

    – Competing activities and projects can interfere with implementing new knowledge and approaches. The purpose, therefore, was to investigate processes and impact related to implementing two concurrent quality initiatives in a Swedish hospital. These were a regionally initiated, system-wide organizational learning programme called the Dynamic and Viable Organization (DVO) and a national initiative on stopping healthcare-associated and hospital-acquired infections (SHAI). Both undertakings aspired to increase staff competence in systematic improvement approaches.

    Design/methodology/approach

    – Multiple methods were applied including surveys, observations, interviews, process diaries, documents and organizational measurements. Respondents were unit managers, change facilitators and improvement team members.

    Findings

    – Even though both initiatives shared the same improvement approach, there was no strong indication that they were strategically combined to benefit each other. The initiatives existed side by side with some coordination and some conflict. Despite absent management strategies to utilize the national SHAI initiative, positive developments in QI culture and communication were reported. The current study illustrates the inherent difficulties coordinating change initiatives, even in favourable circumstances.

    Orginality/value

    – This article addresses the lesser studied but common situation of coinciding and competing projects in organizations.

  • 36. Nyström, Monica
    et al.
    Hansson, Johan
    Garvare, Rickard
    Andersson Bäck, Monica
    Locally based research and development units as knowledge brokers and change facilitators in health and social care of older people in Sweden2015Ingår i: Evidence & Policy: A Journal of Research, Debate and Practice, ISSN 1744-2648, E-ISSN 1744-2656, Vol. 11, nr 1, s. 57-80Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This article investigates the role of locally based research and development units (R&Ds) focusing on health and social services. Nearly 300 local R&Ds are funded by the Swedish government with the intention to facilitate knowledge transfer and development of high quality and effective health and social care organisations. Based on analyses of archival data on aims, activities and outputs of R&Ds focusing on care for older people the authors argue that local R&Ds have potentials to act as knowledge brokers, change agents and researchers, but these overlapping roles need clarified strategies and enactment of a variety of skills.

  • 37.
    Nyström, Monica
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Höög, Elisabet
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Andersson Bäck, M
    Garvare, Rickard
    Hansson, J
    Framtidens välfärdstjänster: Nya arbetssätt för innovativ serviceutveckling inom vård och omsorg2014Rapport (Övrigt vetenskapligt)
    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.

  • 38.
    Nyström, Monica
    et al.
    Karolinska institutet.
    Strehlenert, H
    Hansson, J
    Hasson, H
    Strategies to facilitate implementation and sustainability of large system transformations: A case study of a national program for improving the quality of care for the elderly people2014Konferensbidrag (Övrigt vetenskapligt)
  • 39.
    Richter Sundberg, Linda
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Garvare, Rickard
    Department of Business Administration, Technology and Social Sciences, Luleå University of Technology.
    Nyström, Monica Elisabeth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet.
    Reaching beyond the review of research evidence: a qualitative study of decision making during the development of clinical practice guidelines for disease prevention in healthcare2017Ingår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 17, nr 1, artikel-id 344Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The judgment and decision making process during guideline development is central for producing high-quality clinical practice guidelines, but the topic is relatively underexplored in the guideline research literature. We have studied the development process of national guidelines with a disease-prevention scope produced by the National board of Health and Welfare (NBHW) in Sweden. The NBHW formal guideline development model states that guideline recommendations should be based on five decision-criteria: research evidence; curative/preventive effect size, severity of the condition; cost-effectiveness; and ethical considerations. A group of health profession representatives (i.e. a prioritization group) was assigned the task of ranking condition-intervention pairs for guideline recommendations, taking into consideration the multiple decision criteria. The aim of this study was to investigate the decision making process during the two-year development of national guidelines for methods of preventing disease.

    METHODS: A qualitative inductive longitudinal case study approach was used to investigate the decision making process. Questionnaires, non-participant observations of nine two-day group meetings, and documents provided data for the analysis. Conventional and summative qualitative content analysis was used to analyse data.

    RESULTS: The guideline development model was modified ad-hoc as the group encountered three main types of dilemmas: high quality evidence vs. low adoptability of recommendation; insufficient evidence vs. high urgency to act; and incoherence in assessment and prioritization within and between four different lifestyle areas. The formal guideline development model guided the decision-criteria used, but three new or revised criteria were added by the group: 'clinical knowledge and experience', 'potential guideline consequences' and 'needs of vulnerable groups'. The frequency of the use of various criteria in discussions varied over time. Gender, professional status, and interpersonal skills were perceived to affect individuals' relative influence on group discussions.

    CONCLUSIONS: The study shows that guideline development groups make compromises between rigour and pragmatism. The formal guideline development model incorporated multiple aspects, but offered few details on how the different criteria should be handled. The guideline development model devoted little attention to the role of the decision-model and group-related factors. Guideline development models could benefit from clarifying the role of the group-related factors and non-research evidence, such as clinical experience and ethical considerations, in decision-processes during guideline development.

  • 40.
    Richter Sundberg, Linda
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Garvare, Rickard
    Luleå tekniska universitet, Institutionen för ekonomi, teknik och samhälle, enheten för Industriell ekonomi.
    Nyström, Monica Elisabeth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Karolinska institutet, Department of Learning, Informatics, Management and Ethics, Medical Managment Centre.
    Reaching beyond the review of research evidence: A qualitative study of decision-making during clinical guideline developmentManuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Background: The judgment and decision-making process during guideline development is central for producing high-quality clinical practice guidelines, but the topic is relatively underexplored in the guideline research literature. We studied the development process of national guidelines with a disease-prevention scope produced by the National board of Health and Welfare (NBHW) in Sweden. The NBHW formal guideline development model states that guideline recommendations should be based on four decision-criteria: research evidence; severity of the condition; cost-effectiveness; and ethical considerations. A group of health profession representatives is assigned the task of ranking condition–intervention pairs for guideline recommendations, taking into consideration the multiple decision criteria. The aim of this study was to investigate the decision-making process during the two-year development of national guidelines for methods of preventing disease.

    Methods: A qualitative longitudinal case study approach was used to investigate the decision-making process. Questionnaires, non-participant observations of nine two-day group meetings, and documents provided data for the analysis.

    Results: The guideline development model was adapted ad-hoc as the group encountered three main types of dilemmas: high quality evidence vs low adoptability of recommendation; insufficient evidence vs high urgency to act; and incoherence in vertical and horizontal judgments. Decision-criteria added by the group were ‘clinical knowledge and experience’, ‘potential guideline consequences’ and ‘needs of vulnerable groups’. Gender, professional status, and interpersonal skills were perceived to affect individuals’ relative influence on group discussions. Decision criteria changed over time in the group discussions.

    Conclusions: The study shows that guideline-development groups make compromises between rigour and pragmatism. The formal guideline-development model incorporated multiple aspects, but offered few details on how the different criteria should be merged. The guideline development model devoted little attention to the role of the decision-model and group-related factors. Guideline development models could benefit from incorporating more guidance on if and how to integrate research evidence with other types of decision criteria, such as clinical experience and socioeconomic evidence.

  • 41.
    Richter-Sundberg, Linda
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm.
    Kardakis, Therese
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm.
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Garvare, Rickard
    Nyström, Monica E
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm.
    Addressing implementation challenges during guideline development - A case study of Swedish national guidelines for methods of preventing disease.2015Ingår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 15, nr 1, s. 19-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BackgroundMany of the world¿s life threatening diseases (e.g. cancer, heart disease, stroke) could be prevented by eliminating life-style habits such as tobacco use, unhealthy diet, physical inactivity and excessive alcohol use. Incorporating evidence-based research on methods to change unhealthy lifestyle habits in clinical practice would be equally valuable. However gaps between guideline development and implementation are well documented, with implications for health care quality, safety and effectiveness. The development phase of guidelines has been shown to be important both for the quality in guideline content and for the success of implementation. There are, however, indications that guidelines related to general disease prevention methods encounter specific barriers compared to guidelines that are diagnosis-specific. In 2011 the Swedish National board for Health and Welfare launched guidelines with a preventive scope. The aim of this study was to investigate how implementation challenges were addressed during the development process of these disease preventive guidelines.MethodsSeven semi-structured interviews were conducted with members of the guideline development management group. Archival data detailing the guideline development process were also collected and used in the analysis. Qualitative data were analysed using content analysis as the analytical framework.ResultsThe study identified several strategies and approaches that were used to address implementation challenges during guideline development. Four themes emerged from the analysis: broad agreements and consensus about scope and purpose; a formalized and structured development procedure; systematic and active involvement of stakeholders; and openness and transparency in the specific guideline development procedure. Additional factors concerning the scope of prevention and the work environment of guideline developers were perceived to influence the possibilities to address implementation issues.ConclusionsThis case study provides examples of how guideline developers perceive and approach the issue of implementation during the development and early launch of prevention guidelines. Models for guideline development could benefit from an initial assessment of how the guideline topic, its target context and stakeholders will affect the upcoming implementation.

  • 42.
    Richter-Sundberg, Linda
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Nyström, Monica Elisabeth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Department of Learning, Informatics, Management and Ethics, Medical Management Center, Karolinska Institutet, Stockholm, Sweden.
    Krakau, Ingvar
    Sandahl, Christer
    Improving treatment of depression in primary health care: a case study of obstacles to perform a clinical trial designed to implement practice guidelines2015Ingår i: Primary Health Care Research and Development, ISSN 1463-4236, E-ISSN 1477-1128, Vol. 16, nr 2, s. 188-200Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim The aim of this study is to investigate factors contributing to the failure of a randomized clinical trial designed to implement and test clinical practice guidelines for the treatment of depression in primary health care (PHC).

    BACKGROUND: Although the occurrence of depression is increasing globally, many patients with depression do not receive optimal treatment. Clinical practice guidelines for the treatment of depression, which aim to establish evidence-based clinical practice in health care, are often underused and in need of operationalization in and adaptation to clinical praxis. This study explores a failed clinical trial designed to implement and test treatment of depression in PHC in Sweden.

    METHOD: Qualitative case study methodology was used. Semi-structured interviews were conducted with eight participants from the clinical trial researcher group and 11 health care professionals at five PHC units. Additionally, archival data (ie, documents, email correspondence, reports on the clinical trial) from the years 2007-2010 were analysed.

    FINDINGS: The study identified barriers to the implementation of the clinical trial in the project characteristics, the medical professionals, the patients, and the social network, as well as in the organizational, economic and political context. The project increased staff workload and created tension as the PHC culture and the research activities clashed (eg, because of the systematic use of questionnaires and changes in scheduling and planning of patient visits). Furthermore, there was a perception that the PHC units' management did not sufficiently support the project and that the project lacked basic incentives for reaching a sustainable resolution. Despite efforts by the project managers to enhance and support implementation of the innovation, they were unable to overcome these barriers. The study illustrates the complexity and barriers of performing clinical trials in the PHC.

  • 43. Sparring, Vibeke
    et al.
    Granström, Emma
    Sachs, Magna Andreen
    Brommels, Mats
    Nyström, Monica E
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE-17177 Stockholm, Sweden.
    One size fits none: a qualitative study investigating nine national quality registries' conditions for use in quality improvement, research and interaction with patients2018Ingår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 18, artikel-id 802Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Swedish National Quality Registries (NQRs) are observational clinical registries that have long been seen as an underused resource for research and quality improvement (QI) in health care. In recent years, NQRs have also been recognised as an area where patients can be involved, contributing with self-reported experiences and estimations of health effects. This study aimed to investigate what the registry management perceived as barriers and facilitators for the use of NQRs in QI, research, and interaction with patients, and main activities undertaken to enhance their use for these purposes. The aim was further to identify potential differences between various types of NQRs for their use in these areas.

    Methods: In this multiple case study, nine NQRs were purposively selected. Interviews (n = 18) were conducted and analysed iteratively using conventional and directed content analysis.

    Results: A recent national investment initiative enabled more intensive work with development areas previously identified by the NQR management teams. The recent focus on value-based health care and other contemporary national healthcare investments aiming at QI and public benchmarking were perceived as facilitating factors. Having to perform double registrations due to shortcomings in digital systems was perceived as a barrier, as was the lack of authority on behalf of the registry management to request participation in NQRs and QI activities based on registry outcomes. The registry management teams used three strategies to enhance the use of NQRs: ensuring registering of correct and complete data, ensuring updated and understandable information available for patients, clinicians, researchers and others stakeholders, and intensifying cooperation with them. Varied characteristics of the NQRs influenced their use, and the possibility to reach various end-users was connected to the focus area and context of the NQRs.

    Conclusions: The recent national investment initiative contributed to already ongoing work to strengthen the use of NQRs. To further increase the use, the demands of stakeholders and end-users must be in focus, but also an understanding of the NQRs' various characteristics and challenges. The end-users may have in common a need for training in the methodology of registry based research and benchmarking, and how to be more patient-centred.

  • 44.
    Strehlenert, H
    et al.
    Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm.
    Richter-Sundberg, Linda
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm.
    Nyström, Monica
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm.
    Hasson, H
    Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm; Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm; Center for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden.
    Evidence-informed policy formulation and implementation: a comparative case study of two national policies for improving health and social care in Sweden2015Ingår i: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 10, nr 1, s. 169-179Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Evidence has come to play a central role in health policymaking. However, policymakers tend to use other types of information besides research evidence. Most prior studies on evidence-informed policy have focused on the policy formulation phase without a systematic analysis of its implementation. It has been suggested that in order to fully understand the policy process, the analysis should include both policy formulation and implementation. The purpose of the study was to explore and compare two policies aiming to improve health and social care in Sweden and to empirically test a new conceptual model for evidence-informed policy formulation and implementation.

    METHODS: Two concurrent national policies were studied during the entire policy process using a longitudinal, comparative case study approach. Data was collected through interviews, observations, and documents. A Conceptual Model for Evidence-Informed Policy Formulation and Implementation was developed based on prior frameworks for evidence-informed policymaking and policy dissemination and implementation. The conceptual model was used to organize and analyze the data.

    RESULTS: The policies differed regarding the use of evidence in the policy formulation and the extent to which the policy formulation and implementation phases overlapped. Similarities between the cases were an emphasis on capacity assessment, modified activities based on the assessment, and a highly active implementation approach relying on networks of stakeholders. The Conceptual Model for Evidence-Informed Policy Formulation and Implementation was empirically useful to organize the data.

    CONCLUSIONS: The policy actors' roles and functions were found to have a great influence on the choices of strategies and collaborators in all policy phases. The Conceptual Model for Evidence-Informed Policy Formulation and Implementation was found to be useful. However, it provided insufficient guidance for analyzing actors involved in the policy process, capacity-building strategies, and overlapping policy phases. A revised version of the model that includes these aspects is suggested.

  • 45. Tolf, Sara
    et al.
    Nyström, Monica E
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Department of Learning Informatics, Management and Ethics, Karolinska Institutet, Stockholm.
    Tishelman, Carol
    Brommels, Mats
    Hansson, Johan
    Agile, a guiding principle for health care improvement?2015Ingår i: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 28, nr 5, s. 468-493Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: The purpose of this paper is to contribute to increased understanding of the concept agile and its potential for hospital managers to optimize design of organizational structures and processes to combine internal efficiency and external effectiveness.

    DESIGN/METHODOLOGY/APPROACH: An integrative review was conducted using the reSEARCH database. Articles met the following criteria: first, a definition of agility; second, descriptions of enablers of becoming an agile organization; and finally, discussions of agile on multiple organizational levels. In total, 60 articles qualified for the final analysis.

    FINDINGS: Organizational agility rests on the assumption that the environment is uncertain, ranging from frequently changing to highly unpredictable. Proactive, reactive or embracive coping strategies were described as possible ways to handle such uncertain environments. Five organizational capacities were derived as necessary for hospitals to use the strategies optimally: transparent and transient inter-organizational links; market sensitivity and customer focus; management by support for self-organizing employees; organic structures that are elastic and responsive; flexible human and resource capacity for timely delivery. Agile is portrayed as either the "new paradigm" following lean, the needed development on top of a lean base, or as complementary to lean in distinct hybrid strategies.

    PRACTICAL IMPLICATIONS: Environmental uncertainty needs to be matched with coping strategies and organizational capacities to design processes responsive to real needs of health care. This implies that lean and agile can be combined to optimize the design of hospitals, to meet different variations in demand and create good patient management.

    ORIGINALITY/VALUE: While considerable value has been paid to strategies to improve the internal efficiency within hospitals, this review raise the attention to the value of strategies of external effectiveness.

  • 46. Uzochukwu, B
    et al.
    Onwujekwe, O
    Etiaba, E
    Mbachu, C
    Okwuosa, C
    Nyström, Monica
    Gilson, L
    The challenges of bridging the gap between researchers and policy makers: experiences of getting research into policy and practice in Nigeria2014Konferensbidrag (Refereegranskat)
  • 47.
    Uzochukwu, Benjamin
    et al.
    Enugu, Nigeria.
    Mbachu, Chinyere
    Enugu, Nigeria.
    Onwujekwe, Obinna
    Enugu, Nigeria.
    Okwuosa, Chinenye
    Enugu, Nigeria.
    Etiaba, Enyi
    Enugu, Nigeria.
    Nyström, Monica E.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Karolinska Institutet, Stockholm, Sweden.
    Gilson, Lucy
    Cape Town, South Africa; London, UK.
    Health policy and systems research and analysis in Nigeria: examining health policymakers' and researchers' capacity assets, needs and perspectives in south-east Nigeria.2016Ingår i: Health Research Policy and Systems, ISSN 1478-4505, E-ISSN 1478-4505, Vol. 14, artikel-id 13Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Health policy and systems research and analysis (HPSR+A) has been noted as central to health systems strengthening, yet the capacity for HPSR+A is limited in low- and middle-income countries. Building the capacity of African institutions, rather than relying on training provided in northern countries, is a more sustainable way of building the field in the continent. Recognising that there is insufficient information on African capacity to produce and use HPSR+A to inform interventions in capacity development, the Consortium for Health Policy and Systems Analysis in Africa (2011-2015) conducted a study with the aim to assess the capacity needs of its African partner institutions, including Nigeria, for HPSR+A. This paper provides new knowledge on health policy and systems research assets and needs of different stakeholders, and their perspectives on HPSR+A in Nigeria.

    METHODS: This was a cross-sectional study conducted in the Enugu state, south-east Nigeria. It involved reviews and content analysis of relevant documents and interviews with organizations' academic staff, policymakers and HPSR+A practitioners. The College of Medicine, University of Nigeria, Enugu campus (COMUNEC), was used as the case study and the HPSR+A capacity needs were assessed at the individual, unit and organizational levels. The HPSR+A capacity needs of the policy and research networks were also assessed.

    RESULTS: For academicians, lack of awareness of the HPSR+A field and funding were identified as barriers to strengthening HPSR+A in Nigeria. Policymakers were not aware of the availability of research findings that could inform the policies they make nor where they could find them; they also appeared unwilling to go through the rigors of reading extensive research reports.

    CONCLUSION: There is a growing interest in HPSR+A as well as a demand for its teaching and, indeed, opportunities for building the field through research and teaching abound. However, there is a need to incorporate HPSR+A teaching and research at an early stage in student training. The need for capacity building for HPSR+A and teaching includes capacity building for human resources, provision and availability of academic materials and skills development on HPSR+A as well as for teaching. Suggested development concerns course accreditation, development of short courses, development and inclusion of HPSR+A teaching and research-specific training modules in school curricula for young researchers, training of young researchers and improving competence of existing researchers. Finally, we could leverage on existing administrative and financial governance mechanisms when establishing HPSR+A field building initiatives, including staff and organizational capacity developments and course development in HPSR+A.

  • 48. Uzochukwu, Benjamin
    et al.
    Onwujekwe, Obinna
    Mbachu, Chinyere
    Okwuosa, Chinenye
    Etiaba, Enyi
    Nyström, Monica E
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, 171 77 Stockholm, Sweden.
    Gilson, Lucy
    The challenge of bridging the gap between researchers and policy makers: experiences of a Health Policy Research Group in engaging policy makers to support evidence informed policy making in Nigeria2016Ingår i: Globalization and Health, ISSN 1744-8603, E-ISSN 1744-8603, Vol. 12, artikel-id 67Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Getting research into policy and practice (GRIPP) is a process of going from research evidence to decisions and action. To integrate research findings into the policy making process and to communicate research findings to policymakers is a key challenge world-wide. This paper reports the experiences of a research group in a Nigerian university when seeking to 'do' GRIPP, and the important features and challenges of this process within the African context.

    METHODS: In-depth interviews were conducted with nine purposively selected policy makers in various organizations and six researchers from the universities and research institute in a Nigerian who had been involved in 15 selected joint studies/projects with Health Policy Research Group (HPRG). The interviews explored their understanding and experience of the methods and processes used by the HPRG to generate research questions and research results; their involvement in the process and whether the methods were perceived as effective in relation to influencing policy and practice and factors that influenced the uptake of research results.

    RESULTS: The results are represented in a model with the four GRIPP strategies found: i) stakeholders' request for evidence to support the use of certain strategies or to scale up health interventions; ii) policymakers and stakeholders seeking evidence from researchers; iii) involving stakeholders in designing research objectives and throughout the research process; and iv) facilitating policy maker-researcher engagement in finding best ways of using research findings to influence policy and practice and to actively disseminate research findings to relevant stakeholders and policymakers. The challenges to research utilization in health policy found were to address the capacity of policy makers to demand and to uptake research, the communication gap between researchers, donors and policymakers, the management of the political process of GRIPP, the lack of willingness of some policy makers to use research, the limited research funding and the resistance to change.

    CONCLUSIONS: Country based Health Policy and Systems Research groups can influence domestic policy makers if appropriate strategies are employed. The model presented gives some direction to potential strategies for getting research into policy and practice in the health care sector in Nigeria and elsewhere.

  • 49.
    Weinehall, Lars
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Nyström, Monica
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Karolinska Institutet.
    Garvare, Rickard
    Luleå tekniska universitet.
    Johansson, Helene
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Kardakis, Therese
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Sundberg, Linda
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Höög, Elisabet
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Nyström, Berit
    Staben för verksamhetsutveckling, Västerbottens läns landsting.
    Nationella Riktlinjer för vårdens hälsofrämjande arbete: utmaningen att gå från evidens till klinisk tillämpning. Slutrapport från Vinnvårdsprojekt A2008-0252014Rapport (Övrigt vetenskapligt)
  • 50.
    Westerlund, Anna
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Eurenius, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Garvare, Rickard
    Nyström, Monica
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Parental support strengthened by the International Child Development Program: the implementation process2014Konferensbidrag (Övrigt vetenskapligt)
12 1 - 50 av 58
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