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  • 1. Garvare, Rickard
    et al.
    Westerlund, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Höög, Elisabet
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Nyström, Monica
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Health care improvement and learning : a study of emerging islands and system-wide approaches2011Conference paper (Refereed)
  • 2. Hansson, Johan
    et al.
    Höög, Elisabet
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Department of Learning Informatics Management and Ethics (LIME) and Medical Management Centre (MMC), Karolinska Institutet, Stockholm, Sweden.
    Nyström, Monica
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. 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 unit2017In: Action Research, ISSN 1476-7503, E-ISSN 1741-2617, Vol. 15, no 4, p. 339-356Article in journal (Refereed)
    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.

  • 3.
    Höög, Elisabet
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Navigera i ständig förändring: facilitering av utvecklingsarbete inom vård och omsorg2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

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

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

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

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

  • 4.
    Höög, Elisabet
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. 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 University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Nyström, Monica
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm.
    Challenges in managing a multi-sectoral health promotion program2013In: Leadership in Health Services, ISSN 1751-1879, E-ISSN 1751-1887, Vol. 26, no 4, p. 368-386Article in journal (Refereed)
    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.

  • 5.
    Höög, Elisabet
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. 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 University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. 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 approachManuscript (preprint) (Other academic)
  • 6.
    Höög, Elisabet
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. 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 University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. 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 approcachManuscript (preprint) (Other academic)
  • 7.
    Höög, Elisabet
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Lysholm, Jack
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Garvare, Rickard
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Nystrom, Monica Elisabeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Quality improvement in large healthcare organizations Searching for system-wide and coherent monitoring and follow-up strategies2016In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 30, no 1, p. 133-153Article in journal (Refereed)
    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.

  • 8.
    Höög, Elisabet
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm.
    Lysholm, Jack
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Garvare, Rickard
    Division of Business Administration and Industrial Engineering, Luleå University of Technology, Luleå.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Nyström, Monica Elisabeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. 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 strategiesIn: Article in journal (Other academic)
  • 9.
    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 förändring2014Report (Other academic)
  • 10. Nyström, Monica E
    et al.
    Bergman, Ulf
    Garvare, Rickard
    Höög, Elisabet
    Zingmark, Karin
    Ökad kapacitet för innovativt utvecklingsarbete i närsjukvården: en utveckling av flexibla stödkoncept2019Report (Other academic)
  • 11.
    Nyström, Monica E
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet.
    Höög, Elisabet
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. 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 region2018In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 18, article id 376Article in journal (Refereed)
    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.

  • 12.
    Nyström, Monica E.
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Westerlund, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Höög, Elisabet
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Millde-Luthander, Charlotte
    Högberg, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Grunewald, Charlotta
    Healthcare system intervention for prevention of birth injuries: process evaluation of self-assessment, peer review, feedback and agreement for change2012In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 12, article id 274Article in journal (Refereed)
    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.

  • 13.
    Nyström, Monica Elisabeth
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology. Karolinska institutet.
    Höög, Elisabet
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Karolinska institutet.
    Garvare, Rickard
    Luleå tekniska universitet.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Change and learning strategies in large scale change programs: describing the variation of strategies used in a health promotion program2013In: Journal of Organizational Change Management, ISSN 0953-4814, E-ISSN 1758-7816, Vol. 26, no 6, p. 1020-1044Article in journal (Refereed)
    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.

  • 14.
    Nyström, Monica
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Garvare, R
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Eurenius, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Höög, Elisabet
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Edvardsson, Kristina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Westerlund, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Stening, L
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    På väg mot uthållighet i innovationer och organisatoriskt lärande inom vården: Slutrapport från Vinnvårdsprojekt A 20070342013Report (Other academic)
  • 15.
    Nyström, Monica
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Höög, Elisabet
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Andersson Bäck, M
    Garvare, Rickard
    Hansson, J
    Framtidens välfärdstjänster: Nya arbetssätt för innovativ serviceutveckling inom vård och omsorg2014Report (Other academic)
    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.

  • 16.
    Weinehall, Lars
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Nyström, Monica
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Karolinska Institutet.
    Garvare, Rickard
    Luleå tekniska universitet.
    Johansson, Helene
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Kardakis, Therese
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Sundberg, Linda
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Höög, Elisabet
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    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 A2008-0252014Report (Other academic)
  • 17.
    Westerlund, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Garvare, Rickard
    Department of Business Administration, Luleå University of Technology, Luleå, Sweden.
    Höög, Elisabet
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Department of Learning, Information, Management and Ethics, Karolinska Institutet, Stockholm.
    Nyström, Monica
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Department of Learning, Information, Management and Ethics, Karolinska Institutet, Stockholm.
    Facilitating system-wide organizational change in health care2015In: International Journal of Quality and Service Sciences, ISSN 1756-669X, E-ISSN 1756-6703, Vol. 7, no 1, p. 72-89Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

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

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