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  • 1.
    Andersson, Anders-Petter
    et al.
    The Oslo School of Architecture and Design.
    Cappelen, Birgitta
    The Oslo School of Architecture and Design.
    Designing empowering vocal and tangible interaction: 2013Inngår i: The International conference on new interfaces for musical expression / [ed] Kyogu Lee, Kaejeon, Korea: Seoul National University , 2013, 406-412 s.Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Our voice and body are important parts of our self-experience, and our communication and relational possibilities. They gradually become more important for Interaction Design due to increased development of tangible interaction and mobile communication. In this paper we present and discuss our work with voice and tangible interaction in our ongoing research project RHYME. The goal is to improve health for families, adults and children with disabilities through use of collaborative, musical, tangible media. We build on the use of voice in Music Therapy and on a humanistic health approach. Our challenge is to design vocal and tangible interactive media that through use reduce isolation and passivity and increase empowerment for the users. We use sound recognition, generative sound synthesis, vibrations and cross-media techniques to create rhythms, melodies and harmonic chords to stimulate voice-body connections, positive emotions and structures for actions.

  • 2.
    Andersson, Anders-Petter
    et al.
    Högskolan Kristianstad, Sektionen för hälsa och samhälle. Högskolan Kristianstad, Forskningsplattformen Hälsa i samverkan.
    Cappelen, Birgitta
    The Oslo School of Architecture and Design.
    Vocal and tangible technology for music and health2013Inngår i: Book of abstracts: setting the tone: cultures of relating and reflecting in music therapy / [ed] Gro Trondalen, Oslo: The Norwegian Academy of Music , 2013, 24-24 s.Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Our voice and body are important parts of our self-expression and self-experience. They are also essential for our way to communicate and build relations cross borders like abilities, ages, locations, backgrounds and cultures. Voice and tangibility gradually become more important when developing new music technology for the Music Therapy and the Music and Health fields, due to new technology possibilities that have recently arisen. For example smartphones, computer games and networked, social media services like Skype. In this paper we present and discuss our work with voice and tangible interaction in our ongoing research project. The goal is to improve health for families, adults and children with severe disabilities through use of collaborative, musical, tangible sensorial media. We build on use of voice in Music Therapy and studies by Lisa Sokolov, Diane Austin, Kenneth Bruscia and Joanne Loewy. Further we build on knowledge from Multi-sensory stimulation and on a humanistic health approach. Our challenge is to design vocal and tangible, sensorially stimulating interactive media, that through use reduce isolation and passivity and increase empowerment for all the users. We use sound recognition, generative sound synthesis, vibrations and cross- media techniques, to create rhythms, melodies and harmonic chords to stimulate body- voice connections, positive emotions and structures for actions. The reflections in this paper build on action research methods, video observations and research-by-design methods. We reflect on observations of families and close others with children with severe disabilities, interacting in three vocal and tangible installations.

  • 3.
    Andersson, Johanna
    et al.
    Nordic School of Public Health, Sweden.
    Axelsson, Runo
    Nordic School of Public Health, Sweden.
    Bihari Axelsson, Susanna
    Nordic School of Public Health, Sweden.
    Eriksson, Andrea
    Nordic School of Public Health, Sweden.
    Åhgren, Bengt
    Nordic School of Public Health.
    Integration in Vocational Rehabilitation: a Literature Review2011Inngår i: Integration inHealth and Healthcare: abstract book, 2011Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Context: With the increasing specialisation of services, integration has become important for health and other welfare organisations in order to address the complex problems of their patients or clients. This is particularly in care of the elderly, psychiatric care and vocational rehabilitation. The following presentation reports a review of literature on integration in vocational rehabilitation, focusing on models of integration as well as barriers and facilitators.

    Methods: The review was based on a search in scientific journals from 1995 to 2010. It generated 13132 articles, which were reduced to 1005 after an initial overview. The abstracts were read by members of the research group. Each abstract was read by two members independently. If they agreed the article was included or excluded, but if not the whole group discussed the abstract. This procedure reduced the number of articles to 205, which were read in full text. Finally, 62 articles were included for thematic content analysis.

    Results: Most of the studies came from Sweden, while others came from Canada, Australia, UK, Netherlands, Norway and Denmark. In these studies different models of integration were identified. They were classified as structural or process oriented. The structural models included case management, partnerships, co-location and financial coordination, while the process oriented models included informal contacts, interorganisational meetings and multidisciplinary teams. There were also a number of barriers as well as facilitators of integration. The barriers included structural and cultural differences, while communication, trust and continuity were important facilitators.

    Discussion: There are different models of integration, but also many combinations. Case management is often combined with interorganisational meetings or multidisciplinary teams. There are also informal contacts in all models. There is a clear mirror effect between the different barriers and facilitators. Leadership may be either a barrier or a facilitator. In the same way, differences between organisations may be both barriers and facilitators. These results seem to be valid also for other fields of integration, for example care of the elderly, psychiatric care, and other forms of community care.

  • 4.
    Andersson, Johanna
    et al.
    Nordic School of Public Health.
    Åhgren, Bengt
    Nordic School of Public Health.
    Assessing outcome in collaboration: the impact of assessment on collaboration practice2013Inngår i: Critical Management Studies Conference 2013: The University of Manchester. Abstracts, 2013Konferansepaper (Annet vitenskapelig)
    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.

  • 5.
    Andersson, Johanna
    et al.
    Nordic School of Public Health, Gothenburg.
    Åhgren, Bengt
    Nordic School of Public Health, Gothenburg.
    Axelsson, Susanna Bihari
    Nordic School of Public Health, Gothenburg.
    Eriksson, Andrea
    Nordic School of Public Health, Gothenburg.
    Axelsson, Runo
    Sahlgrenska Academy, University of Gothenburg, Sweden and Aalesund University College, Norway.
    Organizational approaches to collaboration in vocational rehabilitation: an international literature review2012Inngår i: International Journal of Integrated Care, ISSN 1568-4156, E-ISSN 1568-4156, Vol. 11, e137- s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: Collaboration between welfare organizations is an important strategy for integrating different health and welfare services. This article reports a review of the international literature on vocational rehabilitation, focusing on different organizational models of collaboration as well as different barriers and facilitating factors.

    Methods: The review was based on an extensive search in scientific journals from 1995 to 2010, which generated more than 13,000 articles. The number of articles was reduced in different steps through a group procedure based on the abstracts. Finally, 205 articles were read in full text and 62 were included for content analysis.

    Results: Seven basic models of collaboration were identified in the literature. They had different degrees of complexity, intensity and formalization. They could also be combined in different ways. Several barriers and facilitators of collaboration were also identified. Most of these were related to factors as communication, trust and commitment.

    Conclusion: There is no optimal model of collaboration to be applied everywhere, but one model could be more appropriate than others in a certain context. More research is needed to compare different models and to see whether they are applicable also in other fields of collaboration inside or outside the welfare system.

  • 6. Axelsson, Runo
    et al.
    Bihari Axelsson, Susanna
    Åhgren, Bengt
    Nordic School of Public Health.
    Utveckling av en hälsofrämjande primärvård på Hisingen: uppföljning och utvärdering 2007-20082008Rapport (Annet vitenskapelig)
  • 7. Axelsson, Runo
    et al.
    Bihari Axelsson, Susanna
    Åhgren, Bengt
    Nordic School of Public Health.
    Utvärdering av DELTA‐samverkan ur Hisingsbornas perspektiv: Utvärderingsrapport2008Rapport (Annet vitenskapelig)
  • 8. Edgren, Lars
    et al.
    Thorpenberg, Stefan
    Åhgren, Bengt
    Den nya influensan A (H1N1) i VGR: Utvärdering med lärande ansats av pandemiplanering inklusive vaccinationsprogram i Västra Götalandsregionen2010Rapport (Annet vitenskapelig)
  • 9.
    Frisack, Johan
    et al.
    Nordic School of Public Health.
    Åhgren, Bengt
    Nordic School of Public Health.
    Röster om patientsäkerhetskultur: Analys av öppna svar från Västra Götalandsregionens patientsäkerhetskulturmätning 20132013Rapport (Annet vitenskapelig)
  • 10.
    Furenbäck, Ingela
    Högskolan Kristianstad, Sektionen för hälsa och samhälle, Avdelningen för Hälsovetenskap. Högskolan Kristianstad, Forskningsplattformen Hälsa i samverkan.
    Improving the quality of care through communication arena2013Inngår i: International Journal of Integrated Care, ISSN 1568-4156, E-ISSN 1568-4156, Vol. 13, nr WCIC Conf SupplArtikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Purpose: Collaboration has become an increasingly more common strategy when developing care sectors while, coincidentally, experience and research show that collaboration development may be problematic in itself. This study aims to achieve better understanding of collaboration processes.

    Method: A local project that aimed at improving the quality of healthcare and social care by developing the co-operation between organizations took place in Sweden, and by using participatory action research, PAR, this process was followed between 2004 and 2008. Material was gathered through participant observation from the perspective of patients, relatives, staff, managers and politicians. A descriptive narrative was compiled and a hermeneutic interpretation was performed.

    Results: Initially, the development of collaboration was impeded due to lack of communication between the participants from various levels within the organizations. With the support of PAR, communication arenas were arranged to handle social interaction as well as different perspectives and conflicts, which led to improved collaboration within the organizations as well as between the care organizations.

    Conclusion: Development of collaboration between organizations reflects how collaboration within one organization works. Collaboration is a social and interpersonal phenomenon, and readily available communication arenas are crucial for its development.

  • 11.
    Garmy, Pernilla
    et al.
    Högskolan Kristianstad, Forskningsplattformen Hälsa i samverkan. Högskolan Kristianstad, Sektionen för hälsa och samhälle, Avdelningen för Sjuksköterskeutbildningarna.
    Jakobsson, Liselotte
    Högskolan Kristianstad, Forskningsplattformen Hälsa i samverkan. Högskolan Kristianstad, Sektionen för hälsa och samhälle, Avdelningen för Sjuksköterskeutbildningarna.
    Utvärdering av ett samverkansprojekt mellan Cancerreahbiliteringsmottagningen och Försäkringskassan i Kristianstad2016Rapport (Annet vitenskapelig)
    Abstract [sv]

    Cancerrehabilitering ska vara en integrerad del av svensk cancervård och alla patienter med cancer och deras närstående ska få möjlighet till rehabiliteringsinsatser utifrån sina individuella behov. Försäkringskassans uppdrag är att besluta om och betala ut en stor del av de förmåner som ingår i socialförsäkringen. För att förbättra bemötandet av sjukskrivna personer med cancer, utsågs två handläggare på Försäkringskassan att inrikta sig på sjukskrivna personer med cancer. Dessa två handläggare fick extra utbildning i ämnet, och ett samarbete inleddes mellan Försäkringskassan och cancerrehabiliteringsmottagningen på Centralsjukhuset i Kristianstad. Det övergripandesyftet med studien var att undersöka patienters och medarbetares erfarenheter och upplevelser av Försäkringskassans och Cancerrehabiliteringsmottagningens insatser. Utvärderingens form har teoretiskt inspirerats av metoder som beskriver vikten av att forskningspersoner görs delaktiga i forskning och utvärdering och därmed bidrar till kunskapsutveckling. Datainsamlingen bestod av enkäter och fokusgruppsintervjuer och både kvantitativa och kvalitativa analyser har använts. Slutsatsen är att patienterna är övervägande nöjda med bemötandet från såväl handläggarna på Försäkringskassan och på Cancerrehabiliteringsmottagningen, men att mer insatser krävs för att nå alla patienter.

  • 12. Hartveit, Miriam
    et al.
    Biringer, E
    Åhgren, Bengt
    Nordic School of Public Health.
    Vanhaecht, K
    Aslaksen, A
    Should we introduce Care Pathways to Mental Health Care?: a literature review2013Konferansepaper (Annet vitenskapelig)
  • 13.
    Hjalmarson, Helene Victoria
    et al.
    University of Karlstad.
    Åhgren, Bengt
    Nordic School of Public Health.
    Kjolsrud, Margaretha Strandmark
    University of Karlstad.
    Developing interprofessional collaboration: A longitudinal case of secondary prevention for patients with osteoporosis2013Inngår i: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 27, nr 2, 161-170 s.Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 14.
    Holmberg, Leif
    Högskolan Kristianstad, Institutionen för ekonomi.
    Task uncertainty and rationality in medical problem solving2006Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 18, nr 6, 458-462 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    ISSUE:

    Medical problem-solving situations are characterized by various degrees of 'task uncertainty'--i.e. uncertainty related to the definition of a problem, the effect of a technology, the value of a solution, and so on. The need for professional discretion varies and depends on the degree of perceived task uncertainty. SUGGESTED

    SOLUTION:

    In this report it is argued that, in order to obtain rationality in problem-solving processes, differences in the degree of task uncertainty need to be met by variation in the structure of the health care organization.

    IMPLICATIONS:

    The main implications of this view are that (under norms of rationality) problem-solving processes with low task uncertainty must be organized in one way and processes with high task uncertainty in another. Furthermore, processes with high and low task uncertainty also need to be evaluated according to different standards. Some hypotheses regarding the different organizational requirements are presented.

  • 15. Johansson, Ulla
    et al.
    Larsson, Jörgen
    Rothenberg, Elisabet
    Sahlgrenska universitetssjukhuset.
    Stene, Christina
    Unosson, Mitra
    Bosaeus, Ingvar
    Nutritionsbehandling inom slutenvården: Svenska sjukhus klarar inte Europarådets riktlinjer2006Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 103, nr 21-22, 1718-1724 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [sv]

    Sjukdomsrelaterad undernäring har beskrivits i Europa sedan ett tiotal år. Problemet har föranlett Europarådet att 2003 anta en resolution med rekommendationer till medlemsländerna om nutritionsbehandling på sjukhus.

    I en enkätstudie genomförd bland svenska läkare, sjuksköterskor och dietister undersöktes attityder till och rutiner för nutritionsbehandling inom slutenvården – i relation till Europarådets rekommendationer.

    Totalt 1 656 personer (38 procent) svarade på enkäten. Av dessa ansåg 88 procent att nutritionsstatus ska screenas vid inläggning, medan endast 22 procent beskrev att så verkligen sker. Nästan hälften ansåg att utbildningen i klinisk nutrition för vårdpersonal var otillräcklig. En otydlighet i ansvarsfördelningen beskrevs av majoriteten av dem som svarat.

    Undersökningen visar att svensk slutenvård inte lever upp till Europarådets rekommendationer om nutritionsbehandling. Brister har också definierats vad gäller riktlinjer och organisation.

    För framtiden efterlyses en nationell handlingsplan för att implementera Europarådets resolution i svensk hälso- och sjukvård.

  • 16.
    Ledwith, Margaret
    et al.
    University of Cumbria.
    Springett, Jane
    Högskolan Kristianstad, Sektionen för Hälsa och Samhälle.
    Participatory practice : community-based action for transformative change2009Bok (Annet (populærvitenskap, debatt, mm))
    Abstract [en]

    Participatory Practice explores the core ideas of participatory practice and how theory and practice can be integrated to achieve transformative change.

    The ideas in the book are founded on two premises: firstly, that transformative practice begins in the everyday stories that people tell about their lives and that practical theory generated from these narratives is the best way to inform both policy and practice. Secondly, that participatory practice is a tool for examining this knowledge in that it allows practitioners to examine the way they view the world and to situate their local practice within bigger social issues.

    The book  is expected to be of interest to both academics and community-based practitioners.

    Professor Springett commented: “Writing the book was a transformative experience in itself because we had to cross the divide between our different professions. The idea to write it came from our joint concern for the appropriation of the language of participation by many politicians and agencies without a real examination of what true participation actually consists of."

  • 17.
    Leppänen, Vesa
    Högskolan Kristianstad, Sektionen för Hälsa och Samhälle.
    Inledning2008Inngår i: Holmström, i. (red.), Telefonrådgivning inom hälso- och sjukvård, Lund: Studentlitteratur , 2008, 19-36 s.Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 18.
    Leppänen, Vesa
    Högskolan Kristianstad, Sektionen för Hälsa och Samhälle.
    Maktutövning i telefonrådgivning2008Inngår i: Holmström, i. (red.), Telefonrådgivning inom hälso- och sjukvård, Lund: Studentlitteratur , 2008, 19-36 s.Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 19. Nordgren, Lars
    et al.
    Åhgren, Bengt
    Nordic School of Public Health, Göteborg.
    Choice of primary care in Sweden: a discourse analysis of citizen statements2011Inngår i: Offentlig Förvaltning. Scandinavian Journal of Public Administration, ISSN 2000-8058, E-ISSN 2001-3310, Vol. 15, nr 3, 25-40 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Through a discourse analysis of the end-users’ statements on their choice of primary care, there is a focus on how they use certain discourses in society with regard to which discourses governs their choices of primary care. For this purpose, a group interview was administered in a location in the south of Sweden. It was strategically designed to on the whole include individuals with following characteristics: age between 20-45 years, and 65 year or older, and also living in a small community. The following main discourses have been identified in the discussion; freedom of choice; i.e. to say that one has actively chosen one’s health centre or doctor, to be able to reject and re-select care-givers, networking; i.e. ‘to say that friends’ and acquaintances’ experiences affect the choice of a new health centre and professional service, i.e. to say that doctors and other staff should give professional service. It seems like choice of care has improved the possibilities of the citizens to choose preferred care provider, or drop one due to dissatisfaction. When implementing reforms in health care it is valuable to take into account the voices of the users, as they are able to contribute to the development of health care.

  • 20. Nordgren, Lars
    et al.
    Åhgren, Bengt
    Choice of primary care in Sweden: an explorative study of citizen statements based on discourse analysis2011Inngår i: Proceedings QMOD Conference on Quality and Service Sciences 2011: from learnability, innovability and sustainability : book of full papers / [ed] Carmen Jaca, Ricardo Mateo, Elizabeth Viles & Javier Santos, Pamplona, Spanien: Servicios de Publicaciones Universidad de Navarra , 2011, 1337-1350 s.Konferansepaper (Annet vitenskapelig)
  • 21.
    Nordgren, Lars
    et al.
    Lunds universitet.
    Åhgren, Bengt
    Nordic School of Public Health.
    The value creation-concept in hospitals: Health values from the patients’ perspective2013Inngår i: Nordisk sygeplejeforskning, ISSN 1892-2678, E-ISSN 1892-2686, Vol. 3, nr 2, 105-116 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim: Based on the concept of value creation the aim was to analyse a sample of patients’ unstructured responses, and to show what the patients perceived to be healthcare values.

    Method: Using content analysis the patients’ responses to three questions underwent a categorization involving the identification, coding, and emerging of themes.

    Results: This is good: fellow feeling, receptivity, proficiency, efforts matched to requirements, popular food, informed patients. The theme was professional care. This I would like to change: offer more conventional forms of accommodation, better quality food, better cleaning, more time to their patients, better information, and improved accessibility. The theme was patients want good service when in hospital. Other complaints were linked to care, resulting in; improve personal integrity, friendlier demeanour, more focusing on the individual. The theme was patients expect to be acknowledged and respected by nursing staff. However, the answers did not convey anything essentially new.

    Conclusion: The patients expressed different values. It is debatable to use service management concepts in healthcare in a simplistic way. Practice implications: Patients’ unstructured answers are of interest in improving the attitudes of the co-workers.

  • 22. Nordgren, Lars
    et al.
    Åhgren, Bengt
    Val av primärvård: resultat från en brukarundersökning baserad på invånarepaneler2010Rapport (Annet vitenskapelig)
  • 23.
    Nordgren, Lars
    et al.
    Lunds universitet.
    Åhgren, Bengt
    Nordic School of Public Health.
    Öppna svar från Nationell Patientenkät: Blekingesjukhuset – ett pilotprojekt2012Rapport (Annet vitenskapelig)
  • 24.
    Papastavrou, Evridiki
    et al.
    Cyprus University of Technology.
    Acaroglu, Rengin
    Istanbul University.
    Sendir, Merdiye
    Istanbul University.
    Berg, Agneta
    Högskolan Kristianstad, Sektionen för hälsa och samhälle, Avdelningen för Hälsovetenskap II. Högskolan Kristianstad, Forskningsplattformen Hälsa i samverkan.
    Efstathiou, Georgios
    Ministry of Health, Cyprus.
    Idvall, Ewa
    Malmö University.
    Kalafati, Maria
    National and Kapodistrian University of Athens.
    Katajisto, Jouko
    University of Turku.
    Leino-Kilpi, Helena
    University of Turku.
    Lemonidou, Chryssoula
    National and Kapodistrian University of Athens.
    da Luz, Maria Deolinda Antunes
    Unidade de Investigaca˜o e Desenvolvimento em Enfermagem (UI&DE), Escola Superior de Enfermagem de Lisboa.
    Suhonen, Riitta
    University of Turku.
    The relationship between individualized care and the practice environment: an international study2015Inngår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 52, nr 1, 121-133 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Previous research studies have found that the better the quality of practice environments in hospitals, the better the outcomes for nurses and patients. Practice environment may influence nurses' ability to individualize care but the detailed relationship between individualized care and the professional practice environment has not been investigated widely. Some evidence exists about the association of practice environments with the level of individualization of nursing care, but this evidence is based on single national studies.

    OBJECTIVES: The aim of this study was to determine whether nurses' views of their professional practice environment associate with their views of the level of care individualization in seven countries.

    DESIGN: This study had an international, multisite, prospective, cross-sectional, exploratory survey design.

    SETTINGS: The study involved acute orthopedic and trauma surgical inpatient wards (n=91) in acute care hospitals (n=34) in seven countries, Cyprus, Finland, Greece, the State of Kansas, USA, Portugal, Sweden, and Turkey.

    PARTICIPANTS: Nurses (n=1163), registered or licensed practical, working in direct patient care, in orthopedic and trauma inpatient units in acute care hospitals in seven countries participated in the study.

    METHODS: Self-administered questionnaires, including two instruments, the Revised Professional Practice Environment and the Individualized Care Scale-Nurse (Individualized Care Scale-Nurse A and B) were used for data collection. Data were analyzed statistically using descriptive statistics, simultaneous multiple regression analysis, and generalized linear model.

    RESULTS: Two regression models were applied to assess the predictive validity of the Revised Professional Practice Environment on the Individualized Care Scale-Nurse-A and B. The results showed that elements of the professional practice environment were associated with care individualization. Internal work motivation, cultural sensitivity, control over practice, teamwork, and staff relationship with physicians were predictors of support (Individualized Care Scale-A) for and the delivery (Individualized Care Scale-B) of individualized care.

    CONCLUSIONS: The results of this study provide evidence that environment aspect could explain variations in care individualization. These findings support the assertion that individualized care needs to be understood in a broader context than the immediate nurse-patient relationship and that careful development of the care environment may be an effective way to improve care quality and outcomes.

  • 25.
    Petersson, Pia
    et al.
    Högskolan Kristianstad, Sektionen för hälsa och samhälle.
    Springett, Jane
    Liverpool John Morse University.
    Augustinsson, Sören
    Högskolan Kristianstad, Sektionen för hälsa och samhälle.
    Blomqvist, Kerstin
    Högskolan Kristianstad, Sektionen för hälsa och samhälle.
    Local interpretations of health policy concepts: the exemple of Närsjukvård in SwedenManuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    Health care systems in Europe face many challenges requiring greater integration of health and social care. The health policy response in government financed health systems has varied but a consistent feature has been continual change in an attempt to secure greater efficiencies and to meet patient expectations concerning service quality. This paper explores the manifestation of this phenomenon in a subregion of Sweden, where a new concept ‘Närsjukvård’ (literally Nearby Care) was introduced. Method: Data was collected through interviews and questionnaires. A convenience sample of 57 practitioners and managers was interviewed. A questionnaire with four statements based upon the findings from the interviews was answered by 1361 practitioners, managers and politicians working in primary health care, in municipalities and in hospitals. Results: The findings illustrated that the concept was interpreted as; accessibility to hospital beds, accessibility to primary health care, collaboration between care providers and continuity and developed home care. The study revealed different understanding and interpretations partly depending on the respondents’ professional domain and their organisational elonging. Conclusion: A prerequisite for creating a common meaning to the expression ‘Närsjukvård’ is that activities that help the creation of meaning are offered at and between all domain levels and organisations.

  • 26.
    Rudenstam, Nils-Gunnar
    et al.
    Högskolan Kristianstad, Sektionen för hälsa och samhälle, Avdelningen för Ekonomi. Högskolan Kristianstad, Forskningsmiljön Governance, Regulation, Internationalization and Performance (GRIP).
    Holmberg, Leif
    Högskolan Kristianstad, Sektionen för hälsa och samhälle, Avdelningen för Ekonomi. Högskolan Kristianstad, Forskningsmiljön Organisatorisk Samverkan.
    Inter-organizational cooperation: a rehabilitation project based on cooperation between health care and three social service agencies2014Inngår i: Health, ISSN 1949-4998, E-ISSN 1949-5005, Vol. 6, nr 5, 342-349 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: Cooperation between organizations is an often-suggested remedy for handling unsolved borderland problems. However, actual projects aiming at cooperation are seldom very successful. The purpose here is to highlight obstacles related to cooperation between different organizations based on a case study of a rehabilitation project where health care and several social service organizations (social insurance, social welfare, and the local employment agency) were involved. Data were gathered through participation and interviews. Findings: It seems that efficient cooperation requires an understanding of the participating organizations’ differences in work logic as well as work practices. Furthermore, only certain fairly standardized “normal” problems may be handled through organized cooperation while non-routine exceptional problem requires a more fully integrated work organization. Implications: Obstacles to cooperation are highlighted and ways to improve the possibilities of cooperation between organizations are suggested although such possibilities are generally hampered by differences in work logic.

  • 27. Sanneving, Linda
    et al.
    Kulane, Asli
    Iyer, Aditi
    Åhgren, Bengt
    Nordic School of Public Health.
    Health system capacity: maternal health policy implementation in the state of Gujarat, India2013Inngår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, 19629- s.Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 28.
    Werntoft, Elisabet
    et al.
    Lunds universitet.
    Edberg, Anna-Karin
    Lunds universitet.
    The views of physicians and politicians concerning age-related prioritisation in healthcare.2009Inngår i: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 23, nr 1, 38-52 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: The aim of this study is to describe the view of age-related prioritisation in health care among physicians and healthcare politicians and to compare their views regarding gender and age.

    DESIGN/METHODOLOGY/APPROACH: Swedish physicians (n=390) and politicians (n=310), mean age 52 years, answered an electronic questionnaire concerning age-related priority setting in healthcare. The questionnaire had fixed response alternatives with possibility of adding comments.

    FINDINGS: A majority of the participants thought that age should not influence prioritisation, although more physicians than politicians thought that younger patients should be prioritised. There were also significant differences concerning their views on lifestyle-related diseases and on who should make decisions concerning both vertical and horizontal prioritisation. The comments indicated that the politicians referred to ethical principles as a basis for their standpoints while the physicians often referred to the importance of biological rather than chronological age.

    RESEARCH LIMITATIONS/IMPLICATIONS: Web-based surveys as a method has its limitations as biased samples and biased returns could cause major problems, such as limited control over the drop-outs. The sample in this study was, however, judged to be representative.

    PRACTICAL IMPLICATIONS: The results indicate that supplementary guiding principles concerning prioritisation in healthcare are needed in order to facilitate decision-making concerning resource allocation on a local level.

    ORIGINALITY/VALUE: This paper adds important knowledge about decision makers' views on age-related priorities in healthcare, thus contributing to scientific base for prioritisation in healthcare and the ongoing debate in society.

  • 29.
    Werntoft, Elisabet
    et al.
    Lunds universitet.
    Rahm Hallberg, Ingalill
    Lunds universitet.
    Elmståhl, Sölve
    Lunds Universitet.
    Edberg, Anna-Karin
    Lunds universitet.
    Older people's views on how to finance increasing health-care costs2006Inngår i: Ageing & Society, ISSN 0144-686X, E-ISSN 1469-1779, Vol. 26, nr 3, 497-514 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aims of this paper are to investigate both older people's views about ways in which to finance health-care costs and their willingness to pay for treatment themselves, along with variations in these views by age and gender. The data are from the Good Ageing in Skåne (GAS) prospective longitudinal cohort study in Sweden, which involved medical examinations and a survey of living arrangements and socio-economic conditions. For the analysis reported in this paper, 930 GAS respondents aged 60–93 years were invited to participate in an additional structured interview, and 902 (97%) accepted. The sample was divided into the ‘young-old’ (aged 60–72 years), ‘old-old’ (78–84 years) and ‘oldest-old’ (87–93 years). It was found that the participants recommended increasing health-care funding by higher taxes and that they were willing to pay themselves for specific treatments, e.g. cosmetic surgery and medication to combat impotence and obesity. Many were also willing to pay privately for cataract surgery, to shorten the wait, although the respondent's financial circumstances associated with this willingness. Significantly more men than women, and of the ‘young-old’ than of the other two age groups, would pay for cataract surgery. The views of people aged 85 or more years differed from those of the young-old, e.g. significantly fewer believed that older people's health care received too little resource. Views about how to finance health care thus differed among the age groups and between men and women.

  • 30.
    Willumsen, Elisabeth
    et al.
    University of Stavanger, Stavanger, Norway,.
    Åhgren, Bengt
    Nordic School of Public Health, Gothenburg.
    Odegard, Atle
    Molde University College, Molde, Norway.
    A conceptual framework for assessing interorganizational integration and interprofessional collaboration2012Inngår i: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 26, nr 3, 198-204 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The need for collaboration in health and social welfare is well documented internationally. It is related to the improvement of services for the users, particularly target groups with multiple problems. However, there is still insufficient knowledge of the complex area of collaboration, and the interprofessional literature highlights the need to develop adequate research approaches for exploring collaboration between organizations, professionals and service users. This paper proposes a conceptual framework based on interorganizational and interprofessional research, with focus on the concepts of integration and collaboration. Furthermore, the paper suggests how two measurement instruments can be combined and adapted to the welfare context in order to explore collaboration between organizations, professionals and service users, thereby contributing to knowledge development and policy improvement. Issues concerning reliability, validity and design alternatives, as well as the importance of management, clinical implications and service user involvement in future research, are discussed.

  • 31.
    Åhgren, Bengt
    Nordic School of Public Health.
    A method to access integrated health care2006Inngår i: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 83, nr Supplement, 71-74 s.Artikkel i tidsskrift (Fagfellevurdert)
  • 32. Åhgren, Bengt
    Bäst när vårdkedja initieras underifrån2007Inngår i: Dagens samhälle, ISSN 1652-6511, nr 24, 20- s.Artikkel i tidsskrift (Annet (populærvitenskap, debatt, mm))
  • 33.
    Åhgren, Bengt
    Bohlin & Stromberg, a Solving International Company, Malmö.
    Chain of care development in Sweden: results of a national study2003Inngår i: International journal of integrated care, ISSN 1568-4156, Vol. 3, e01- s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Chains of Care are today an important counterbalance to the ever-increasing fragmentation of Swedish health care, and the ongoing development work has high priority. Improved quality of care is the most important reason for developing Chains of Care. Despite support in the form of goals and activity plans, seven out of ten county councils are uncertain whether they have been quite successful in the development work. Strong departmentalisation of responsibilities between different medical professions and departments, types of responsibilities and power still remaining in the vertical organisation structure, together with limited participation from the local authorities, are some of the most commonly mentioned reasons for the lack of success. Even though there is hesitation regarding the development work up to today, all county councils will continue developing Chains of Care. The main reason is, as was the case with Chain of Care development up to today, to improve quality of care. Although one of the main purposes is to make health care more patient-focused, patients in general seem to have limited impact on the development work. Therefore, the challenge is to design Chains of Care, which regards patients as partners instead of objects.

  • 34.
    Åhgren, Bengt
    Nordic School of Public Health.
    Chains of care are here to stay2003Konferansepaper (Annet vitenskapelig)
  • 35.
    Åhgren, Bengt
    Nordic School of Public Health.
    Chains of Care provide structure to fragmented health care2003Konferansepaper (Annet vitenskapelig)
  • 36.
    Åhgren, Bengt
    Nordic School of Public Health.
    Competition and integration in Swedish health care2010Inngår i: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 96, nr 2, 91-97 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Despite of an insignificant track record of quasi-market models in Sweden, new models of this kind have recently been introduced in health care; commonly referred to as "choice of care". This time citizens act as purchasers; choosing the primary care centre or family physician they want to be treated by, which, in turn, generates a capitation payment to the chosen unit. Policy makers believe that such systems will be self-remedial, that is, as a result of competition the strong providers survive while unprofitable ones will be eliminated. Because of negative consequences of the fragmented health care delivery, policy makers at the same time also promote different forms of integrated health care arrangements. One example is "local health care", which could be described as an upgraded community-oriented primary care, supported by adaptable hospital services, fitting the needs of a local population. This article reviews if it is possible to combine this kind of integrated care system with a competition driven model of governance, or if they are incompatible. The findings indicate that some choice of care schemes could hamper the development of integration in local health care. However, geographical monopolies like local health care, enclosed in a noncompetitive context, lack the stimulus of competition that possibly improves performance. Thus, it could be argued that if choice of care and local health care should be combined, patients ought to choose between integrated health care arrangements and not among individual health professionals. (C) 2010 Elsevier Ireland Ltd. All rights reserved.

  • 37.
    Åhgren, Bengt
    Nordic School of Public Health.
    Competition-exposed integration: an impossible composition?2013Inngår i: What healthcare can we afford?: Better, quicker, lower cost health services, 2013, 106- s.Konferansepaper (Annet vitenskapelig)
    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.

  • 38.
    Åhgren, Bengt
    Nordic School of Public Health.
    Creating Integrated Care: Evaluation and Management of Local Care in Sweden2007Inngår i: Journal of Integrated Care, ISSN 1476-9018, Vol. 15, nr 6, 14-21 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    It seems impossible to create a comprehensive evaluation model which fully takes into account the multi-dimensional context of integrated health and social care. Clinical integration, as a prerequisite for efficient outcomes of integration, must nonetheless get special attention. For more extensive evaluations, a quality chain matrix, including co-operating acts by different providers, has proven to be useful. Examples of evaluated services in Sweden are given, and the management benefits of the use of evaluation data are highlighted.

  • 39.
    Åhgren, Bengt
    Nordic School of Public Health.
    Creating integrated health care2007Inngår i: International Journal of Integrated Care, ISSN 1568-4156, E-ISSN 1568-4156, Vol. 7, nr Oct-Dec, e38- s.Artikkel i tidsskrift (Annet vitenskapelig)
  • 40.
    Åhgren, Bengt
    Nordic School of Public Health.
    Dissolving the Patient Bermuda Triangle2010Inngår i: International Journal of Care Coordination, ISSN 2053-4354, Vol. 14, nr 4, 137-141 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The differentiation of roles, tasks and responsibilities in health care has gradually increased because of efforts to decentralize, specialize and professionalize our health-care systems. These development approaches can on the one hand be regarded as successful, although there is also a negative flipside. Increased differentiation has concurrently fragmented the delivery of health care, which, in turn, can be divided into structural, clinical and cultural fragmentation. Patients are lost as a result of these conditions of fragmentation. This phenomenon can metaphorically be described as a ‘Patient Bermuda Triangle’. Actions to dissolve the Patient Bermuda Triangles are commonly termed ‘Integrated health care’, a global buzzword that includes integrated care pathway as well as other integrated health-care strategies. Moreover, integrated care is a means to an end: improved patient outcome. To achieve this, it is crucial to have necessary prerequisites in place: both functional and interactional conditions. This procedure seems to be an organic process where the stakeholders go through gradual changes until the optimum level of integration, as well as mutualistic interactions, is established. If these conditions are concealed or impossible to achieve, developmental work should be ended to avoid the evolvement of antagonistic relations between the stakeholders concerned. This state will likely establish a Patient Bermuda Triangle or reinforce an existing one.

  • 41.
    Åhgren, Bengt
    Nordic School of Public Health.
    Evaluering av tverrprofesjonelt samarbeid relatert til klinisk integrering2009Inngår i: Tverrprofesjonelt samarbeid / [ed] Elisabeth Willumsen, Universitetsforlaget, 2009, 139-152 s.Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 42.
    Åhgren, Bengt
    Nordic School of Public Health.
    Health Care Delivery System: Sweden2014Inngår i: The Wiley Blackwell Encyclopedia of Health, Illness, Behavior, and Society / [ed] William C. Cockerham & others, Wiley-Blackwell, 2014, 866-872 s.Kapittel i bok, del av antologi (Fagfellevurdert)
    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.

  • 43.
    Åhgren, Bengt
    Nordic School of Public Health.
    Integrated care development in Sweden: state of the art and future challenges2008Inngår i: E-P-A newsletter, nr Edition 4, 10-11 s.Artikkel i tidsskrift (Annet vitenskapelig)
  • 44.
    Åhgren, Bengt
    Nordic School of Public Health.
    Integration, not fragmentation2012Inngår i: Public service review. Health and social care, ISSN 2045-2357, nr 31, 75-76 s.Artikkel i tidsskrift (Annet vitenskapelig)
  • 45. Åhgren, Bengt
    Intraprenad ett sätt att göra personalen delaktiga2005Inngår i: Dagens medicin, ISSN 1104-7488, nr 34, 33- s.Artikkel i tidsskrift (Annet vitenskapelig)
  • 46. Åhgren, Bengt
    Inventering av FoUU-kostnader inom hälso- och sjukvården i norrlandstingen2005Rapport (Annet vitenskapelig)
  • 47.
    Åhgren, Bengt
    Nordic School of Public Health.
    Is competition and integration incompatible conditions?2010Konferansepaper (Annet vitenskapelig)
  • 48.
    Åhgren, Bengt
    Nordic School of Public Health.
    Is it better to be big? The reconfiguration of 21st century hospitals: Responses to a hospital merger in Sweden2008Inngår i: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 87, nr 1, 92-99 s.Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: Swedish hospital mergers seem to stem from a conviction among policy makers that bigger hospitals lead to lower average costs and improved clinical outcomes. The effects of mergers in the form of multisited hospitals have not been systematically evaluated. The purpose of this article is to contribute to this area of knowledge by exploring responses to the merger of Blekinge Hospital.

    Methods: The evaluation was guided by the philosophy of triangulation. A questionnaire was sent to 597 randomly selected employees, that is 24% of the health care staff. Four hundred ninety-eight employees answered the questionnaire, giving a response rate of 83%. Furthermore, interviews of different groups of stakeholders were conducted.

    Results: A moderate increase of quality was assessed, which, a low proportion of the employees perceived had decisively or largely to do with the merger. The majority perceives economical incentives as the drivers of change, but, at the same time, only 10% of this group believes this target was reached completely or to a large extent.

    Conclusions: The employees believe the merger has neither generated economy of scale advantages nor substantial quality improvement. Instead, it seems more rewarding to promote cross-functional collaboration together with clinical specialisation. Needs for both integration and differentiation could thereby be fulfilled. (c) 2008 Elsevier Ireland Ltd. All rights reserved.

  • 49. Åhgren, Bengt
    Kartläggning av akut- och ambulansverksamheten i Kronoberg2006Rapport (Annet vitenskapelig)
  • 50. Åhgren, Bengt
    Konkurrens och samverkan: oförenliga vårdpolitiska strategier2013Inngår i: Om samverkan: för utveckling av hälsa och välfärd / [ed] Runo Axelsson, Susanna Bihari Axelsson, Studentlitteratur AB, 2013, 107-118 s.Kapittel i bok, del av antologi (Annet vitenskapelig)
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