Search results

The purpose of this paper is to illuminate strengths and limitations in quality improvement work, when involving patients.

The experience-based co-design (EBCD) method was used when improving care for patients undergoing otosclerosis surgery. Individual interviews and focus groups were interpreted using qualitative content analysis.

Strengths mentioned by patients were that their participation made a difference. The first steps were found effective in giving an in-depth view of patients’ experiences and the staff got an increased understanding about specific patient needs. However, weaknesses were found in the latter phases, those of improving and follow-up, health care staff had difficulties to keep their focus on patients’ experiences and invite patients to be involved. Patients’ participation decreased, and there was a lack of tools to support the process.

The content in this paper is mainly based on one case. However, the findings are in congruence with earlier research and add further knowledge to the research area.

The findings can be used in healthcare when involving patients in improvement work.

There is no earlier study which involves patients with otosclerosis when using EBCD. Furthermore, this paper illuminates that there is a need to increase collaboration with patients. The latter phases often seem to be handled by health care professionals without involving patients; this paper suggest a development using dedicated quality tools.

The purpose of this paper is to study how an account of multiple patient roles when using the Kano model in healthcare improvements can support identification of a wide range of patients’ needs.

The study presented in this paper was part of a longitudinal action research study. The empirical material was collected by various methods (interviews, a focus group, participative observations, and a survey) over a two-month period within the Children’s and Women’s Healthcare department in a Swedish hospital. The respondents included the management team, healthcare professionals, patients, and the patients’ partners.

The study shows that incorporating a view of multiple patient roles into application of the Kano model, and using input on customer needs obtained from patients, relatives, and healthcare professionals, helps to identify a wide range of patients’ needs.

The view on patients within healthcare is being transformed from one based on servility to that of patients as customers. This paper elaborates on a hands-on way of applying the Kano model based on a view of multiple patient roles as a means to support this new patient view. The application builds on input from various groups (such as patients and healthcare professionals), and, by using input from various stakeholders. This approach appears to overcome a gap, identified in earlier research, of either relying solely on patients, or solely on healthcare professionals, when identifying patients’ need. Rather input from several groups – patients, relatives, and professionals – are suggested to be used in combination.

The purpose of this paper is to study critical practices when adopting improvement knowledge as a management innovation in a professional organization.

This paper is based on an action research approach, in which practitioners and researchers are seen as a part of a participative community generating actionable knowledge. Research involved gathering data over a five-year period through more than 250 interviews and 25 focus groups.

This paper identifies five critical practices for adopting a management innovation in a professional context: first, focussing on labeling and theorizing to create an organization’s own vocabulary; second, focussing on the role of internal change agents; third, allowing for an evolutionary adoption process; fourth, building new professional competence through the change agents; and fifth, adopting a research-driven approach to the adoption of a management innovation.

For healthcare practitioners, this paper points to practices to consider when adopting improvement knowledge – for example, identifying the patient as the guiding principle and encouraging involvement and local change initiatives. For practitioners in other professionally driven organizations, this paper identifies critical practices for adopting a management innovation – for example, focussing on theorizing and labeling in order to create an organization’s own vocabulary related to the professional context.

On a generic level, this paper contributes to the understanding of critical aspects when adopting management innovations in a professional organization. In a healthcare context, this paper points to the value of improvement knowledge for improving quality of care. Improvement knowledge is relatively new in healthcare, and this study provides an example of a hospital in which this management innovation helped transform the organization.

The purpose of this paper is to identify and improve patient care processes by collaborating patients, relatives and healthcare professionals.

To identify and improve patient care processes by collaborating patients, relatives and healthcare professionals.

Healthcare problems captured from collaboration between patients and healthcare professionals fall into simple, complicated and complex problems. Healthcare staff and patient experiences with patient processes differ, and a collaborative approach is needed to capture all areas needing improvement.

The conclusions are drawn from a project with few participants in a context that probably influenced the results. In contrast, other studies in the same area confirm the results.

The study outcomes have direct implications for healthcare professionals who can learn from patients involved in quality improvements such as this experience-based co-design (EBCD) project.

The paper contributes to limited studies on EBCD involving patients in healthcare quality improvements.

By adopting the “hard” and “soft” project management (PM) approaches from the PM-literature, this paper aims to problematize the expected role of client organizations in driving innovation in the transport infrastructure sector.

Addressing a large public client in Sweden, a case study design was initially applied to provide in-depth insights and perspectives of client project managers’ views and experiences of managing projects expected to drive innovation. In this paper, the concepts of “hard” and “soft” are used to discuss empirical findings on challenges associated with adopting a PM-approach for driving innovation in projects. The empirical material consists of interview data, complemented with observations and archival data.

Findings reveal challenges associated with combining hard and soft approaches, frequently demonstrating difficulties in balancing short-term project expectations with the promotion of innovation. In line with the literature, project managers note that there is a need for soft approaches to promote development and drive innovation. Yet, findings reflect a situation in which operational success criteria predominate, whereas soft approaches are not sufficiently used to create the grounds required for fostering innovation.

Insights are provided into how PM-approaches may impact construction innovation in the infrastructure sector, demonstrating a need for further research on the challenges and implications of applying and combining hard and soft PM-approaches.

The purpose of this paper is to investigate the possible associations between health-relevant personality traits and adherence; and if these traits predict adherence to a web-based occupational health intervention.

In total, 563 participants were analyzed using the Health-relevant Personality Inventory. Adherence measures were: logins, utilization of self-help exercises and time spent logged in.

Higher levels of antagonism (a facet of agreeableness) and impulsivity (a facet of conscientiousness) correlated to fewer logins, and higher levels of negative affectivity (a facet of neuroticism) and impulsivity correlated to a higher utilization of self-help exercises. Alexithymia (a facet of openness) negatively predicted self-help exercise utilization and antagonism was a positive predictor. Negative affectivity was a positive predictor of time spent logged in to the intervention. There were sex-related differences in outcomes.

This is the first study to investigate health-relevant personality traits in relation to adherence to a web-based occupational health intervention. The practical implications are that intervention developers could benefit from taking personality into consideration to better understand and improve adherence.

Despite their efficacy, some recommended therapies are underused. The purpose of this paper is to describe clinical decision support system (CDSS) development and its impact on clinical guideline adherence.

A new CDSS was developed and introduced in a cardiac intensive care unit (CICU) in 2003, which provided physicians with patient-tailored reminders and permitted data export from electronic patient records into a national quality registry. To evaluate CDSS effects in the CICU, process indicators were compared to a control group using registry data. All CICUs were in the same region and only patients with acute coronary syndrome were included.

CDSS introduction was associated with increases in guideline adherence, which ranged from 16 to 35 per cent, depending on the therapy. Statistically significant associations between guideline adherence and CDSS use remained over the five-year period after its introduction. During the same period, no relapses occurred in the intervention CICU.

Guideline adherence and healthcare quality can be enhanced using CDSS. This study suggests that practitioners should turn to CDSS to improve healthcare quality.

This paper describes and evaluates an intervention that successfully increased guideline adherence, which improved healthcare quality when the intervention CICU was compared to the control group.

Humans tend to rely on beliefs, assumptions and cognitive rules‐of‐thumb for making judgments and are biased against taking more uncertain alternatives. Such inertia has implications for client organizations' decision making about innovations, which are inherently more uncertain than conventional alternatives. The purpose of this paper is to contribute to furthering the understanding of barriers to overcoming inertia in client decision making in new‐build.

A descriptive behavioural decision‐making perspective is combined with an organizational information‐processing perspective. To identify and discuss individual and organizational barriers that potentially distort clients' decision making on innovation, the analysis addresses aggregated data from four studies. The analysis focuses on inferences and interpretations made by decision makers in Swedish client organizations, their information‐processing practices and the subsequent impacts on perceived meanings and judgments about industrialized multi‐storey, timber‐framed building innovations, which are perceived by Swedish clients as new and different building alternatives.

Cognitive and organizational barriers maintain status‐quo decisions. Clients are inclined to make biased judgments about industrialized‐building alternatives because non‐applicable cognitive rules‐of‐thumb, based on their experiences of conventional‐building alternatives, are used. Furthermore, client organizations' information‐processing practices do not allow different meanings to surface, interact and potentially suggest different conclusions, at odds with established beliefs.

The paper's conclusions highlight how inertia is sustained in client decision making in new‐build. They illustrate the limitations of a common engineering approach, i.e. supporting decision making about innovations by focusing on providing more information to the decision maker in order to reduce uncertainty, as well as managing multiple meanings by reductionism.

The purpose of this paper is to analyze learning in a Swedish trade union board in a workplace, according to contemporary challenges in working life and conditions, of decentralization and local independency of trade union work and learning.

The paper is based on ethnographic studies of two Swedish local trade union boards. The aim is to investigate the everyday activities of the board and the learning processes that were generated. This paper focuses on the study of an experienced trade union board. Theory stressing the situated character of learning is used to understand the changes in participation and the trade union practice. The trade union board's practice is interpreted as solving problems with reference to pragmatism.

The paper finds that the experienced board is competent and manages to independently solve unfamiliar but traditional problems, processes of learning are generated, but it fails to develop the competence and update the practice required for the complex and challenging problems of today on its own.

The local trade union board does not manage to develop the competence giving it the power to independently handle the trade union issues significant for the future of the trade union members and the workplace on its own.

This context of learning has not been studied before. It is a type of workplace learning, but part of a social movement.