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This study aimed to describe facilitators and barriers in terms of regulation and financing of healthcare due to the implementation and use of person-centred care (PCC).

A qualitative design was adopted, using interviews at three different levels: micro = hospital ward, meso = hospital management, and macro = national board/research. Inclusion criteria were staff working in healthcare as first line managers, hospital managers, and officials/researchers on national healthcare systems, such as Bismarck, Beveridge, and mixed/out-of-pocket models, to obtain a European perspective.

Countries, such as Great Britain and Scandinavia (Beveridge tax-based health systems), were inclined to implement and use person-centred care. The relative freedom of a market (Bismarck/mixed models) did not seem to nurture demand for PCC. In countries with an autocratic culture, that is, a high-power distance, such as Mediterranean countries, PCC was regarded as foreign and not applicable. Another reason for difficulties with PCC was the tendency for corruption to hinder equity and promote inertia in the healthcare system.

The sample of two to three participants divided into the micro, meso, and macro level for each included country was problematic to find due to contacts at national level, a bureaucratic way of working. Some information got caught in the system, and why data collection was inefficient and ran out of time. Therefore, a variation in participants at different levels (micro, meso, and macro) in different countries occurred. In addition, only 27 out of the 49 European countries were included, therefore, conclusions regarding healthcare system are limited.

Support at the managerial level, together with patient rights supported by European countries' laws, facilitated the diffusion of PCC.

Fragmented health systems divided by separate policy documents or managerial roadmaps hindered local or regional policies and made it difficult to implement innovation as PCC. Therefore, support at the managerial level, together with patient rights supported by European countries' laws, facilitated the diffusion of PCC.

This study aims to describe how person-centred care, as a concept, has been adopted into discourse in 23 European countries in relation to their healthcare systems (Beveridge, Bismarck, out of pocket).

A literature review inspired by the SPICE model, using both scientific studies (CINHAL, Medline, Scopus) and grey literature (Google), was conducted. A total of 1,194 documents from CINHAL (n = 139), Medline (n = 245), Scopus (n = 493) and Google (n = 317) were analysed for content and scope of person-centred care in each country. Countries were grouped based on healthcare systems.

Results from descriptive statistics (percentage, range) revealed that person-centred care was most common in the United Kingdom (n = 481, 40.3%), Sweden (n = 231, 19.3%), the Netherlands (n = 80, 6.7%), Northern Ireland (n = 79, 6.6%) and Norway (n = 61, 5.1%) compared with Poland (0.6%), Hungary (0.5%), Greece (0.4%), Latvia (0.4%) and Serbia (0%). Based on healthcare systems, seven out of ten countries with the Beveridge model used person-centred care backed by scientific literature (n = 999), as opposed to the Bismarck model, which was mostly supported by grey literature (n = 190).

Adoption of the concept of person-centred care into discourse requires a systematic approach at the national (politicians), regional (guidelines) and local (specific healthcare settings) levels visualised by decision-making to establish a well-integrated phenomenon in Europe.

Evidence-based knowledge as well as national regulations regarding person-centred care are important tools to motivate the adoption of person-centred care in clinical practice. This could be expressed by decision-making at the macro (law, mission) level, which guides the meso (policies) and micro (routines) levels to adopt the scope and content of person-centred care in clinical practice. However, healthcare systems (Beveridge, Bismarck and out-of-pocket) have different structures and missions owing to ethical approaches. The quality of healthcare supported by evidence-based knowledge enables the establishment of a well-integrated phenomenon in European healthcare.

Our findings clarify those countries using the Beveridge healthcare model rank higher on accepting/adopting the concept of person-centered care in discourse. To adopt the concept of person-centred care in discourse requires a systematic approach at all levels in the organisation—from the national (politicians) and regional (guideline) to the local (specific healthcare settings) levels of healthcare.

The purpose of this paper is to describe staff experiences in an on-going improvement project regarding patients with ureteral stones.

A qualitative descriptive study based on eight group interviews and 48 narratives, was performed. Data were analysed using qualitative content analysis. Trustworthiness was ensured by using a well-documented improvement process method during six months.

The results formed three categories: an absent comprehensive view; complexity; and vulnerability within the organisation. A holistic perspective regarding urological care at the micro-, meso- and macro-levels is needed to improve planning and caring processes.

This study includes one team (six members, different health professionals) within the same urology department.

Results show that staff need information, such as guidelines and support throughout the improvement work to deliver high-quality care. Moreover, there is a need for evidence-based guidelines at national level to support improvement work.

Healthcare staff need to pay attention to all team member needs to improve urological care. Organisational and managerial aspect are needed to support clear and common goals regarding healthcare improvement work.

Urological improvement projects, generally, are lacking, which is why this study is important to improve nephrolithiasis patient care.

Purpose - The aim was to describe an improvement project and its effects on decreasing the time from diagnosis to treatment for patients with kidney stones and to reduce the negative effects related to untreated stones at one hospital in western Sweden

Design and methodology - A quantitative descriptive study based on Nolan’s improvement model was used. The quality improvement effects were evaluated using statistical process control (SPC).

Findings – Extracorporeal shock wave lithotripsy ESWL treatment’s positive effects within 48 hours were described as efficiency (decreased waiting time) from diagnosis to treatment, even if a re-treatment was necessary. The results also showed a reduction in the usage of percutaneous nephropyelostomies as a treatment option.

Research limitations - This study includes data from one department at one hospital in one country. Comparative data include the time from acute radiological examination to final treatment but not total re-treatments, complications or time to up following radiological examination. However, the study was performed over one year and analyzed data from medical records in a systematic way.

Practical implications - This study may inspire measuring and developing routines from diagnosis to treatment for patients who are transferred within different departments at one hospital.

Originality - Studies in improvement projects considering ureteral or kidney stones are generally lacking; thus, this study is important for improving the care of patients with this diagnose.

A distinct view of customer participation in services classifies the characteristics of the participation process as experience- versus outcome-oriented, each of which affects customer participation success uniquely for different types of services (utilitarian vs hedonic). This study aims to investigate if service managers should differentiate and focus on distinct characteristics according to the service types.

Two consumer experiments serve to assess the potential moderating effect of service type on consumer preferences for experience- versus outcome-oriented forms of customer participation.

The two empirical studies affirm the proposed moderating effect of service type on the effect of experience- and outcome-oriented customer participation characteristics. Experience-oriented characteristics work better for hedonic than for utilitarian services, and one study confirms a stronger positive effect of outcome-oriented characteristics for utilitarian services.

Further research should replicate the experimental findings with a field study. Furthermore, continued research could analyze the mediators of the interaction of co-production characteristics with the service type in greater detail.

Managers can design the characteristics of the customer participation processes according to the nature of the service (hedonic vs utilitarian) and, thus, maximize customers’ willingness to pay.

This study offers a new perspective on customers’ reactions to customer participation in services: depending on the service type or situation in which a service is being consumed, different customer participation characteristics lead to (financial) success.

This study aims to examine customers’ reactions in service encounters in which the customer contact person (CCP) initially engages in positive social behaviors and then turns to suggestive selling.

An experimental between‐subjects design was employed. The participants interacted in a service encounter with a CCP who engaged in positive social behaviors. At the end of the service encounter, participants were exposed to: no suggestive selling; congruent suggestive selling; or incongruent suggestive selling.

Customers’ intentions to buy additional products were lower in the two suggestive selling conditions than in the condition without suggestive selling. This outcome should be viewed in light of the contrast effect that occurs when the CCP's role comprises both rapport‐building activities and sales activities: suggestive selling near the end of a service encounter may “break the spell” of initial positive social behaviors. However, in terms of the customer's attitude toward the CCP, it was mainly the incongruent suggestive sales attempt that had a negative effect, presumably because congruent suggestive selling contrasts less with positive social behaviors than incongruent suggestive selling.

Researchers have acknowledged that many CCPs who are instructed to engage in positive social behaviors in service encounters are under increasing pressure to also actively engage in sales efforts. However, few studies have examined the reactions of customers exposed to both activities within the same service encounter.

The purpose of this paper is to explore work motivation among professionals at well-functioning primary healthcare centers subject to a national healthcare reform which include financial incentives.

Five primary healthcare centers in Sweden were purposively selected for being well-operated and representing public/private and small/large units. In total, 43 interviews were completed with different medical professions and qualitative deductive content analysis was conducted.

Work motivation exists for professionals when their individual goals are aligned with the organizational goals and the design of the reform. The centers’ positive management was due to a unique combination of factors, such as clear direction of goals, a culture of non-hierarchical collaboration, and systematic quality improvement work. The financial incentives need to be translated in terms of quality patient care to provide clear direction for the professionals. Social processes where professionals work together as cohesive groups, and provided space for quality improvement work is pivotal in addressing how alignment is created.

Leaders need to consistently translate and integrate reforms with the professionals’ drives and values. This is done by encouraging participation through teamwork, time for structured reflection, and quality improvement work.

The design of the reforms and leadership are essential preconditions for work motivation.

The study offers a more complete picture of how reforms are managed at primary healthcare centers, as different medical professionals are included. The value also consists of showing how a range of aspects combine for primary healthcare professionals to successfully manage external reforms.

The purpose of the this study was to explore the development of commitment to change among leaders in the home help services during organizational change and to study this development in relation to workload and stress. During organizational change initiatives, commitment to change among leaders is important to ensure the implementation of the change. However, little is known of development of commitment of change over time.

The study used a qualitative design with semi-structured interviews with ten leaders by the time an organizational change initiative was launched and follow-up one year later. Thematic content analysis was used to analyze the interviews.

Commitment to change is not static, but seems to develop over time and during organizational change. At the first interview, leaders had a varied pattern reflecting different dimensions of commitment to change. One year later, the differences between leaders’ commitment to change was less obvious. Differences in commitment to change had no apparent relationship with workload or stress.

The data were collected from one organization, and the number of participants were small which could affect the results on workload and stress in relation to commitment to change.

It is important to support leaders during organizational change initiatives to maintain their commitment. One way to accomplish this is to use management team meetings to monitor how leaders perceive their situation.

Qualitative, longitudinal and leader studies on commitment to change are all unusual, and taken together, this study shows new aspects of commitment.

The purpose of this paper is to investigate how different notions about the conservation of built heritage develop in a situation of structural change that demands either the demolition or relocation of a large number of historic buildings.

The analysis is based on a case study of the on-going urban transformation of the Swedish mining town Kiruna. The investigation was based on the text analysis of urban planning documents and media reporting, which was used to distinguish stakeholders’ positions towards conservation based on authenticity aspects.

The conservation goals of the urban planning process are unclear and the stakeholders have conceptually different views regarding which parts of the town’s built heritage are of significance, which negatively affects the ability to make well informed, transparent and intelligible management decisions. Stakeholder views on the management of built heritage span from the relocation of a few, single historic buildings to maintaining the integrity of the town as a heritage site by moving a significant number of buildings.

The Kiruna case, being exceptional because conservation in situ is impossible, has the potential to highlight the relation between single historic buildings and the integrity of an urban heritage site, as well as implications for conservation on the urban scale.

This investigation contributes to knowledge of built heritage in situations of structural change, which is of concern for planning and conservation practice. Currently, many urban areas are under pressure of transformations or destruction.