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Åhgren, B. (2014). Health Care Delivery System: Sweden. In: William C. Cockerham & others (Ed.), The Wiley Blackwell Encyclopedia of Health, Illness, Behavior, and Society: (pp. 866-872). Wiley-Blackwell
Open this publication in new window or tab >>Health Care Delivery System: Sweden
2014 (English)In: The Wiley Blackwell Encyclopedia of Health, Illness, Behavior, and Society / [ed] William C. Cockerham & others, Wiley-Blackwell, 2014, p. 866-872Chapter in book (Refereed)
Abstract [en]

In Sweden it is a public sector duty to finance and facilitate the provision of health care. It is thus a “Beveridge” health care system. All residents have accordingly the right to obtain the publicly financed health care. The system is decentralized and includes 21 county councils and 290 municipalities. Furthermore, it rests on a democratic platform: each of these authorities is governed by a parliament, with its representatives elected for a four-year period at every general election.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2014
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hkr:diva-12554 (URN)10.1002/9781118410868.wbehibs285 (DOI)1-4443-3076-4 (ISBN)978-1-4443-3076-2 (ISBN)
Available from: 2014-08-12 Created: 2014-08-12 Last updated: 2014-08-19Bibliographically approved
Andersson, A., Carlström, E. D., Åhgren, B. & Berlin, J. (2014). Managing boundaries at the accident scene: a qualitative study of collaboration exercises. International Journal of Emergency Services, 3(1), 77-94
Open this publication in new window or tab >>Managing boundaries at the accident scene: a qualitative study of collaboration exercises
2014 (English)In: International Journal of Emergency Services, ISSN 2047-0894, E-ISSN 2047-0908, Vol. 3, no 1, p. 77-94Article in journal (Refereed) Published
Abstract [en]

Purpose The purpose of this study is to identify what is practiced during collaboration exercises and possible facilitators for inter-organisational collaboration.

Design/methodology/approach Interviews with 23 participants from four exercises in Sweden were carried out during autumn 2011. Interview data were subjected to qualitative content analysis.

Findings Findings indicate that the exercises tend to focus on intra-organisational routines and skills, rather than developing collaboration capacities. What the participants practiced depended on roles and order of arrival at the exercise. Exercises contributed to practicing leadership roles, which was considered essential since crises are unpredictable and require inter-organisational decision-making.

Originality/value The results of this study indicate that the ability to identify boundary objects, such as injured/patients, was found to be important in order for collaboration to occur. Furthermore, lessons learned from exercises could benefit from inter-organisational evaluation. By introducing and reinforcing certain elements and distinct aims of the exercise, the proactive function of collaboration exercises can be clarified.

Place, publisher, year, edition, pages
Emerald Group Publishing Ltd. United Kingdom, 2014
Keywords
Collaboration, Exercise, Police, Ambulance, Accident, Fire department
National Category
Pedagogical Work Public Administration Studies
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Public health science; SOCIAL SCIENCE, Business administration; SOCIAL SCIENCE, Public administration; SOCIAL SCIENCE, Sociology
Identifiers
urn:nbn:se:hkr:diva-12553 (URN)10.1108/IJES-02-2013-0003 (DOI)
Available from: 2014-08-12 Created: 2014-08-12 Last updated: 2017-12-05Bibliographically approved
Andersson, J. & Åhgren, B. (2013). Assessing outcome in collaboration: the impact of assessment on collaboration practice. In: Critical Management Studies Conference 2013: The University of Manchester. Abstracts. Paper presented at The 8th International Conference in Critical management Studies. Manchester, England, 10-12 July, 2013.
Open this publication in new window or tab >>Assessing outcome in collaboration: the impact of assessment on collaboration practice
2013 (English)In: Critical Management Studies Conference 2013: The University of Manchester. Abstracts, 2013Conference paper, Oral presentation with published abstract (Other academic)
Abstract [en]

Today the concept of efficiency is a guiding light in public management. Increased efficiency is thought to control spending and provide better services. Two approaches to achieve this are through assessments such as evaluation and audits; and collaboration between different actors. Collaboration can imply e.g. networks or partnerships and vary in intensity and formality. Regardless of form, collaborative efforts are generally thought to achieve services better adapted to address complex social problems, and diminishing overlaps and unclear responsibilities caused by fragmentation. Assessments are used to determine whether or not a program or a service is efficient, but the act of assessment itself is also intended to increase efficiency. Thus, the act of assessment influences the practice it is assessing. Furthermore, in order to be assessed, a program or a service has to be “evaluable”, which may also influence practice. Collaboration is often a solution to previous sector failure, and at the same time it is perceived as difficult to both achieve and sustain. Assessments are used as a tool to determine whether or not collaborative advantage is achieved and if the investments in collaboration should be pursued.

Assessments of collaboration are a challenge since it confronts the regular vertical forms of organizing and thereby the focus of assessment. The challenge can be boiled down to the question of what collaborative arrangements can, and should, be held accountable for.

Based on an ethnographic study and two years of field work, this question is critically analyzed with an example from Sweden. The financial coordination of rehabilitation measures act came into effect in 2004, and regulates the construction of coordination associations. The foundation of an association is a pooled budget to which all members, four different public authorities in the field of vocational rehabilitation, contribute. An important condition behind the law was the notion that public services were not adapted to, and therefore had trouble handling, some groups with complex problems needing support from two or more organizations at the same time. The overall, and ultimate, aim with financial coordination is to improve the working ability in the target population. Though the objective of the associations is, according to the law, to support collaboration, finance efforts within the collected area of responsibility and evaluate these efforts. The financed efforts may be both operative and strategic, and should in some way complement the operations of the member organizations or aim at development of new knowledge or methods. The associations have no power to make decisions of authority in relation to the target population, which remains with the professionals in the member organizations. Following this, it may be argued that the first target group of the associations is the regular organizations and next, as a secondary target group; the individuals in the target population. This means also that the target population is not the associations’ own but the regular organizations’ target groups. The aim with the associations is thus to contribute to the regular organizations working better in relation to this group. The associations have no tools at their disposal to contribute to the overall goal but the pooled budget. Their responsibility is to construct the budget, distribute the resources and follow up.

However, as the findings presented and discussed in this paper show, the associations are generally held accountable to more than that in the frequent assessments being performed on both the associations and the efforts they finance. First, the associations are generally seen by others as being the efforts they finance. This makes the view of them almost like a new organization or authority, even though the efforts actually are organizationally owned and performed by regular organizations. Second, they are held accountable to the aim of improved working ability of the target group, i.e. the overall policy goal. Their objective to support collaboration and the notion that the law was introduced in order to ensure that, through collaboration, those individuals in the intersection of different organizations get the needed help is thus overlooked and focus is turned to effects on individuals.

This paper argues that the assessments have highly influenced practice in the associations, and has shifted focus from organizational outcomes such as increased equity and quality of services due to decreased fragmentation, to individual outcomes such as employment and dependency of benefits. These latter outcomes are easier to account for and are also in line with conventional more hierarchical assessments. Since many associations perceive themselves to be questioned due to lacking efficiency, they may start seek legitimacy and thereby behave in line with the focus of assessments and start to “produce” improved working ability instead of supporting collaboration. Furthermore, the assessments and their focus on individuals tend to treat the associations not as a collaborative structure between four actors with a supportive aim, but as a regular organization with authoritative power. When the associations are held accountable for a group’s outcome, this group has been “passed on” from ordinary organizations on to the associations. Organizational outcome related to collaboration is greatly overlooked, in line with the “common wisdom” that collaboration is not an end in itself, and an end in public management collaboration must thus be measured as individual benefit. Increased quality and equity in services are thus outcomes that are not only not being assessed but might also be at risk of being lost with the current assessment focus. Last, there is an evident risk that the narrow and vertical assessment focus increases, instead of decreases, horizontal fragmentation within the welfare system due to its impact on coordination association practice.

National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hkr:diva-12605 (URN)
Conference
The 8th International Conference in Critical management Studies. Manchester, England, 10-12 July, 2013
Available from: 2014-08-19 Created: 2014-08-19 Last updated: 2014-08-19Bibliographically approved
Åhgren, B. (2013). Competition-exposed integration: an impossible composition?. In: What healthcare can we afford?: Better, quicker, lower cost health services. Paper presented at HMA Annual Conference 2013, 26-28 June 2013, Bocconi University, Milano, Italy (pp. 106).
Open this publication in new window or tab >>Competition-exposed integration: an impossible composition?
2013 (English)In: What healthcare can we afford?: Better, quicker, lower cost health services, 2013, p. 106-Conference paper, Oral presentation with published abstract (Other academic)
Abstract [en]

Context

Swedish health care, like many other health care systems, is in a constant development mode to meet never-ending demands for improved efficiency and quality. Competitive and integrative policies are for example concurrently introduced in Swedish primary care; citizens‘ choice of primary care is launched while primary care is expected to integrate its activities with other providers for the creation of =local health care‘. Competition has though a tendency fragment the provision of services. The aim of this study is therefore to explore whether or not these two strategies are compatible in practice.

Methods

Group interviews were conducted at four locations in Sweden. The groups included persons aged between 20 and 45 years, 46 and 64 years and 65 years or over. The interviewees were living either in a big town or in a small community. Altogether, 21 randomly selected individuals participated in the group interviews. A deductive approach was chosen: six question topics were formulated with guidance from a theoretical framework about choice of care. The group interviews were thus semistructured without any predetermined codes. Each group interview took between 1 and 1.5 h to complete. Moreover, the conversations were recorded and transcribed as verbatim reports. As a consequence of the deductive approach, directed content analysis was chosen for the analysis of the group conversations.

Results

Choice of care is executed from the perspectives of being a prospective or current patient, which, in practice, imply choices are performed passive and active respectively. If the later group perceive interpersonal continuity, accessibility and demeanour of health professionals as favourable, they remain faithful to their actively chosen provider. The only condition that seems to trigger this group of patients to reconsider their choices is if they been the subject of bad manners. Those executing passive choices are less faithful to their original choice. When these former prospective patients, often younger persons, are in need of primary care they often disregard their choice if waiting times are shorter at other providers. This group generally prefer accessible service and seldom consider where it is provided. The group of passive choices also include citizens accepting suggestions presented by the authorities, founded on the conviction that ―they know what is best for me.

Discussion

Many patients that have made active choices are thus faithful to their choices. This is rare in a consumer-market, which is characterized by high degree of exchangeability of providers; a condition which by and large corresponds with the attitude of those making passive choices. Nevertheless, a majority of patients stay with their choice of provider, often selected among a limited number of options. Moreover, health care providers and patients have long-term relationships, which is typical of a producer-market. In other words, if politicians strive for a competition-exposed primary care, the competition concept ought not to be founded on the theories of a consumer-market. The principles of a producer-market seem instead to be more applicable, which imply that providers will be competitive if they are able to build stable relations with their patients, which, in turn, facilitate for integrative arrangements among health care providers.

National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hkr:diva-12604 (URN)
Conference
HMA Annual Conference 2013, 26-28 June 2013, Bocconi University, Milano, Italy
Available from: 2014-08-19 Created: 2014-08-19 Last updated: 2014-08-19Bibliographically approved
Hjalmarson, H. V., Åhgren, B. & Kjolsrud, M. S. (2013). Developing interprofessional collaboration: A longitudinal case of secondary prevention for patients with osteoporosis. Journal of Interprofessional Care, 27(2), 161-170
Open this publication in new window or tab >>Developing interprofessional collaboration: A longitudinal case of secondary prevention for patients with osteoporosis
2013 (English)In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 27, no 2, p. 161-170Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to explore the development of interprofessional collaboration aiming to improve secondary prevention of osteoporosis by studying this topic expansively from the perspectives of different stakeholders. The method used was a longitudinal single case study with both qualitative and quantitative data sources. The findings elucidate that the bottom-up structure used triggers a freedom to act for the professionals and a changed leadership. Such an approach seems to make managers aware of the need for a horizontal organizational focus that, in this case, was crucial for developing interprofessional collaboration. Furthermore, the study shows that continuous feedback was central to motivate professionals to collaborate. Constructive feedback was created by interprofessional and patient-centered interaction skills, facilitated by confirming leadership promoting ability to recognize the efficacy of joint collaboration. The interprofessional collaboration resulted in an improved chain of care with increased transparency and collective control with benefits for both patients and providers. Outcomes at the system level showed an appreciable increase in patients investigated for osteoporosis: 88% were followed up in primary care and nearly half had improved their health behavior. The implementation of a bottom-up structure where leaders and professionals are developing interdependency, measuring collective performance and using feedback loops generated, in this case, motivational forces for interprofessional collaboration. It is reasonable to assume that these findings could be transferable to similar healthcare settings.

National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hkr:diva-12558 (URN)10.3109/13561820.2012.724123 (DOI)000315410900009 ()23043549 (PubMedID)
Available from: 2014-08-12 Created: 2014-08-12 Last updated: 2017-12-05Bibliographically approved
Sanneving, L., Kulane, A., Iyer, A. & Åhgren, B. (2013). Health system capacity: maternal health policy implementation in the state of Gujarat, India. Global Health Action, 6, 19629
Open this publication in new window or tab >>Health system capacity: maternal health policy implementation in the state of Gujarat, India
2013 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, p. 19629-Article in journal (Refereed) Published
Abstract [en]

Introduction: The Government of Gujarat has for the past couple of decades continuously initiated several interventions to improve access to care for pregnant and delivering women within the state. Data from the last District Family Heath survey in Gujarat in 2007-2008 show that 56.4% of women had institutional deliveries and 71.5% had at least one antenatal check-up, indicating that challenges remain in increasing use of and access to maternal health care services.

Objective: To explore the perceptions of high-level stakeholders on the process of implementing maternal health interventions in Gujarat. Method: Using the policy triangle framework developed by Walt and Gilson, the process of implementation was approached using in-depth interviews and qualitative content analysis.

Result: Based on the analysis, three themes were developed: lack of continuity; the complexity of coordination; and lack of confidence and underutilization of the monitoring system. The findings suggest that decisions made and actions advocated and taken are more dependent on individual actors than on sustainable structures. The findings also indicate that the context in which interventions are implemented is challenged in terms of weak coordination and monitoring systems that are not used to evaluate and develop interventions on maternal health.

Conclusions: The implementation of interventions on maternal health is dependent on the capacity of the health system to implement evidence-based policies. The capacity of the health system in Gujarat to facilitate implementation of maternal health interventions needs to be improved, both in terms of the role of actors and in terms of structures and processes.

National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hkr:diva-12556 (URN)10.3402/gha.v6i0.19629 (DOI)000316560100001 ()23522352 (PubMedID)
Available from: 2014-08-12 Created: 2014-08-12 Last updated: 2017-12-05Bibliographically approved
Åhgren, B. & Axelsson, R. (2013). Integrated Care: Pathfindings from Sweden. In: Tom O'Connor (Ed.), Integrated care for Ireland in an international context: challenges for policy, institutions and specific service user needs (pp. 90-102). Cork, Ireland: Oak Tree Press
Open this publication in new window or tab >>Integrated Care: Pathfindings from Sweden
2013 (English)In: Integrated care for Ireland in an international context: challenges for policy, institutions and specific service user needs / [ed] Tom O'Connor, Cork, Ireland: Oak Tree Press , 2013, p. 90-102Chapter in book (Other academic)
Place, publisher, year, edition, pages
Cork, Ireland: Oak Tree Press, 2013
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hkr:diva-12589 (URN)9781781190807 (ISBN)1781190801 (ISBN)9781781191040 (ISBN)1781191042 (ISBN)
Available from: 2014-08-18 Created: 2014-08-18 Last updated: 2014-08-19Bibliographically approved
Åhgren, B. (2013). Konkurrens och samverkan: oförenliga vårdpolitiska strategier. In: Runo Axelsson, Susanna Bihari Axelsson (Ed.), Om samverkan: för utveckling av hälsa och välfärd (pp. 107-118). Studentlitteratur AB
Open this publication in new window or tab >>Konkurrens och samverkan: oförenliga vårdpolitiska strategier
2013 (Swedish)In: Om samverkan: för utveckling av hälsa och välfärd / [ed] Runo Axelsson, Susanna Bihari Axelsson, Studentlitteratur AB, 2013, p. 107-118Chapter in book (Other academic)
Place, publisher, year, edition, pages
Studentlitteratur AB, 2013
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hkr:diva-12591 (URN)9789144085227 (ISBN)
Available from: 2014-08-18 Created: 2014-08-18 Last updated: 2014-08-19Bibliographically approved
Frisack, J. & Åhgren, B. (2013). Röster om patientsäkerhetskultur: Analys av öppna svar från Västra Götalandsregionens patientsäkerhetskulturmätning 2013. Göteborg: Nordic School of Public Health
Open this publication in new window or tab >>Röster om patientsäkerhetskultur: Analys av öppna svar från Västra Götalandsregionens patientsäkerhetskulturmätning 2013
2013 (Swedish)Report (Other academic)
Place, publisher, year, edition, pages
Göteborg: Nordic School of Public Health, 2013. p. 49
Series
NHV-rapport, ISSN 0283-1961 ; 2013:6 R
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hkr:diva-12602 (URN)978-91-86739-61-4 (ISBN)
Available from: 2014-08-19 Created: 2014-08-19 Last updated: 2014-08-19Bibliographically approved
Hartveit, M., Biringer, E., Åhgren, B., Vanhaecht, K. & Aslaksen, A. (2013). Should we introduce Care Pathways to Mental Health Care?: a literature review. In: : . Paper presented at European Care Pathways Conference. Glasgow, Scotland, 20-21 June, 2013.
Open this publication in new window or tab >>Should we introduce Care Pathways to Mental Health Care?: a literature review
Show others...
2013 (English)Conference paper, Poster (with or without abstract) (Other academic)
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hkr:diva-12603 (URN)
Conference
European Care Pathways Conference. Glasgow, Scotland, 20-21 June, 2013
Available from: 2014-08-19 Created: 2014-08-19 Last updated: 2014-08-19Bibliographically approved
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-7895-3341

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