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Value-based health care (VBHC) argues that health-care needs to re-focus to maximise value creation, defining value as the quota when dividing the outcomes important for the patient, by the cost for health care to deliver such outcomes. This study aims to explore the perception of value among different stakeholders involved in the process of implementing VBHC at a Swedish hospital to support leaders to be more efficient and effective when developing health care.

Participants comprised 19 clinicians and non-clinicians involved in the implementation of VBHC. Semi-structured interviews were conducted and content analysis was performed.

The clinicians described value as a dynamic concept, dependent on the patient and the clinical setting, stating that improving outcomes was more important than containing costs. The value for non-clinicians appeared more driven by the interplay between the outcome and the cost. Non-clinicians related VBHC to a strategic framework for governance or for monitoring different continuous improvement processes, while clinicians appreciated VBHC, as they perceived its introduction as an opportunity to focus more on outcomes for patients and less on cost containment.

There is variation in how clinicians and non-clinicians perceive the key concept of value when implementing VBHC. Clinicians focus on increasing treatment efficacy and improving medical outcomes but have a limited focus on cost and what patients consider most valuable. If the concept of value is defined primarily by clinicians’ own assumptions, there is a clear risk that the foundational premise of VBHC, to understand what outcomes patients value in their specific situation in relation to the cost to produce such outcome, will fail. Health-care leaders need to ensure that patients and the non-clinicians’ perception of value, is integrated with the clinical perception, if VBHC is to deliver on its promise.

Severe disruptions to maritime supply chains, including port closures, congestion and shortages in shipping capacity, have occurred during the COVID-19 pandemic. This paper’s purpose is to explore flexibility-based countermeasures that enable actors in maritime supply chains to mitigate the effects of disruptions with different characteristics.

Semi-structured interviews were conducted with shipping lines, shippers, forwarders and ports. Data on the COVID-19 pandemic's effects and countermeasures were collected and compared with data regarding the 2016–2017 Gothenburg port conflict.

Spatial, capacity, service and temporal flexibility emerged as the primary countermeasures, whilst important characteristics of disruptions were geographical spread, duration, uncertainty, criticality, the element of surprise and intensity. Spatial flexibility was exercised in both disruptions by switching to alternative ports. During the COVID-19 pandemic, ensuring capacity flexibility included first removing and then adding vessels. Shipping lines exercising service flexibility prioritised certain cargo, which made the spot market uncertain and reduced flexibility for forwarders, importers and exporters that changed carriers or traffic modes. Experience with disruptions meant less surprise and better preparation for spatial flexibility.

Understanding how actors in maritime supply chains exercise flexibility-based countermeasures amid disruptions with different characteristics can support preparedness for coming disruptions.

Comparing flexibility-based measures in a pandemic versus port conflict provides insights into the important characteristics of disruptions and the relevance of mitigation strategies. The resilience of maritime supply chains, although underexamined compared with manufacturing supply chains, is essential for maintaining global supply chain flows.

Early identification of persons at risk is essential in suicide prevention. Undocumented migrants (UM) live under limited conditions and are to a high degree invisible, both in research and in suicide prevention programmes. The aim of this study was to investigate prevalence rates of suicidal thoughts among UM in Sweden.

This cross-sectional study was part of the Swedish Health Research on Undocumented Migrants project (SHERUM). The study population consisted of 104 UM over 18 years of age recruited through informal networks. Data on 112 multiple choice questions was collected via trained interviewers in Gothenburg, Stockholm and Malmö during 2014–2016. To assess suicidal thoughts (the last two weeks) one item asking about suicidal thought in the Beck Depression Inventory scale (BDI-II) was used. Logistic regression and chi-square analyses were made to identify risk and protective factors.

Suicidal thoughts were found in 43.2% of the 88 UM that answered the question on suicidal thoughts. Being a parent had some protective influence on the prevalence of suicidal thoughts while the housing situation, having been exposed to crime and having mental illness were all statistically significant risk factors for suicidal thoughts. However, due to low sample size, few variables presented statistically significant differences.

This study presents an alarmingly high prevalence of suicidal thoughts among undocumented migrants in Sweden, a difficult-to reach, vulnerable and rarely studied group. Targeted strategies are imperative to include undocumented migrants in suicidal prevention programmes.

The purpose of this study is to contribute to firms’ capabilities of digital transformation through the identification of strategies for digital decoupling and recoupling.

This paper reports from multiple studies using a combination of methods such as case studies and clinical studies. The method of analysis involves the revisiting of vignettes from interactions with practitioners with the purpose of analyzing patterns in responses to digital transformation.

The findings consist of four strategies used by organizations and individuals in the decoupling of digital from their existing operations. Digital decoupling affords the organization the possibility of remaining largely unaffected by digital transformation. The authors also present four digital recoupling strategies that are used to succeed with digital transformation.

This study is limited by the analytical approach of drawing from multiple previous studies. The research implications consist primarily of a contribution to a better understanding of why and how digital transformation is constrained.

The four strategies of digital decoupling can be used to identify behavior in organizations that limit digital transformation. The four strategies of digital recoupling can be used to instigate a more successful digital transformation.

According to the authors’ knowledge, this study is the first to identify digital decoupling strategies as a micro-foundation for organizational resistance to digital transformation.

For the case of Sweden, this paper aims to determine how a range of different infrastructure fees and taxes influences modal split, port throughputs, air emissions, societal costs of greenhouse gas (GHG) emissions and air pollution, as well as logistics costs.

The Swedish national freight model is used to simulate a range of different proposed infrastructure fees, one by one and in combination. The volume of emissions of CO₂-equivalents, NOx, SOx and PM under the different scenarios is calculated in both volume and monetary terms, by applying national emission factors and EU values for external costs.

Road user fees are calculated to have the largest impact on the modal split, GHG emissions and air pollution. The impact increases slightly when road user fees are combined with higher fees for sea and rail and/or gate fees in all Swedish ports. The imposition of gate fees over €30 per truck in all ports leads to shifts in cargo to land-based modes and to ports outside Sweden. The logistics costs in Sweden are found to be three to ten times higher than the benefits of reduced GHG emissions and air pollution, although other benefits to society need to be considered as well.

Methods which attempt to evaluate alternative approaches to the internalisation of the external costs caused by transport need to be further developed. In particular, they need to encompass a more holistic perspective on “benefits to society”, other than merely reductions in GHG emissions and air pollution. To facilitate international acceptance and adoption, such methods require agreements to be reached on common definitions and routines.

The results can be used as basis for policy-making. They illustrate the environmental impacts of the fees and taxes one by one and in combination and to what extent these reinforce each other and should be co-ordinated.

The outcomes are relevant to national and international policymakers and authorities, as well as port authorities, shippers and transport companies who need to determine unilateral strategies on how to reduce GHG emissions and air pollution, without undermining their wider business objectives.

The approach is original in facilitating the testing of policies which impact on the transport system and the environment across different dimensions. The work has additional value in informing policy because of its use of Sweden’s national freight transport model.

Process facilitation as part of a complex intervention for changing or improving practices within workplaces is becoming a common work method. The aim of this study was to investigate what characterizes the process-facilitating role in a complex intervention.

The present study focuses on a complex work environment intervention targeting eight organizational units (workplaces) in the Swedish healthcare sector. The study applies a mixed-method approach and has been carried out in two steps. First, a qualitative process evaluation was performed. Secondly, an evaluation was conducted to see to what extent these identified conditions and mechanisms affected the quantitative intervention effect in term of sickness absence.

The analysis shows that the facilitating role consisted of three overlapping and partially iterative phases. These phases involved different activities for the facilitating role. Depending on how the facilitating role and the intervention were designed, various supporting conditions were found to significantly affect the outcome of the intervention measured as the total sickness absence.

It is concluded that the facilitation is not static or fixed during the change process. Instead, the facilitation role develops and emerges through the process of support during the different implementation phases.

The facilitative role of performing support is based on a combination of support role activities and expert role activities. The support role focuses on support activities, while the expert role includes capacity building through knowledge- and legitimacy-oriented activities.

This study contributes to earlier research by developing a methodological approach for carrying out process facilitation in complex interventions.

The circular economy (CE) has been endorsed as representing a model that is able to achieve environmental protection through decreased use of raw materials, together with changing economic values and social inclusion thanks to its demand for a wide variety of skill profiles. This has motivated many policy initiatives to support the implementation of the CE. The purpose of this study is to follow such policy initiatives in three geographically anchored industry-specific networks.

The study contributes to the research debate on the CE through a spatial approach with a focus on how the implementation of the CE is conditioned by spatial and regional contexts. The authors investigate three different networks in Sweden for CE with different locations and industrial profiles.

The findings reveal the difficulty that exist in relation to the implementation of the CE. The network and support functions in combination with private industry are vital. The risk of sustaining an uneven regional economic development is evident.

Although research on the development of the CE has proliferated, geographical approaches to this development are comparably rare to date. The authors seek to contextualise the strategy development and policy implementation of a CE policy.

Since 2006, higher education institutions (HEIs) in Sweden, should according to the Higher Education Act, promote sustainable development (SD). In 2016, the Swedish Government asked the Swedish higher education authority to evaluate how this study is proceeding. The authority chose to focus on education. This paper aims to produce a report on this evaluation.

All 47 HEIs in Sweden were asked to write a self-evaluation report based on certain evaluation criteria. A panel was appointed consisting of academics and representatives for students and working life. The panel wrote an evaluation of each HEI, a report on general findings and recommendations, and gave an overall judgement of each HEI in two classes as follows: the HEI has well-developed processes for integration of SD in education or the HEI needs to develop their processes.

Overall, a mixed picture developed. Most HEIs could give examples of programmes or courses where SD was integrated. However, less than half of the HEIs had overarching goals for integration of SD in education or had a systematic follow-up of these goals. Even fewer worked specifically with pedagogy and didactics, teaching and learning methods and environments, sustainability competences or other characters of education for SD. Overall, only 12 out of 47 got a higher judgement.

This is a unique study in which all HEIs in a country are evaluated. This provides unique possibilities for identifying success factors and barriers. The importance of the leadership of the HEIs became clear.

The purpose of this paper is to investigate and theoretically explain how line managers and lower-status experts work together in public health-care organizations. Hence, this study explores how lower-status experts influence line managers' decision-making and task prioritizing in order to guide staff experts' cooperation and performance improvements.

The authors used a qualitative method for data collection and analysis of the experts' and line managers' explanations about their cooperation. A theoretical approach of experts' identity positioning, in terms of differences and similarities, was used in analyzing the interaction between managers and experts.

This study shows that similarities and differences in positioning acts exist simultaneously. Similarity is constructed by way of strategic and professional alignment with the line managers' core tasks. Differences stem from the distinction between knowledge-grounded skills and professional attributes such as language, analytical tools, and jargon. Lower-status experts need to leave their entrenched positions and match the professional status of line managers in both knowledge aspirations and appearance to reach a respected approach of experts' identity positioning.

Unlike many previous studies, this study demonstrates that similarities and differences in positioning acts exist simultaneously.

The purpose of the paper is to contribute to an understanding of the relational work carried out in mentoring programmes and the implications for learning capabilities in future practices.

This study is based on field research of a mentoring programme bringing together senior and newly graduated workers in a large Swedish health care organisation. In total, 54 qualitative interviews with mentors, mentees, HR, managers and union representatives are included.

The findings point to the role of trust and a psychological sense of community in the socialisation work that goes on in relationships between the mentor and the mentee. This in turn leads to increased social capital in the form of learning and retaining workers. The conditions for being vulnerable and asking questions, as well as daring to be independent, are an essential and decisive part of constructing bonding within the professional group and bridging out to other professions and parts of the organisation.

The practical contribution from this study is the workplace conditions that are central to organising mentoring programmes, with implications for learning capabilities in future practices.

With its theoretical focus on social capital, the study shows the importance of relationships for learning and retaining both newly graduated and experienced employees in a context of high employee turnover. It is central to achieving strong and mutually beneficial relationships through continual and trustful interaction between actors. By using the concepts of social capital, socialisation agents and psychological sense of community, this study contributes to an understanding of mentoring and workplace learning.