Handling a challenging context: experiences of facilitating evidence-based elderly care (original) (raw)
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ObjectiveThe objective of this paper is to describe the initial phase of a long-term collaboration initiative between a municipality and the medical faculty at a university in Sweden. The overall ambition of the collaboration is to strengthen the quality of care for older people. The concrete goal is to equip academically trained registered health care professionals (HCP) with tools for transferring evidence-based knowledge into practice. As municipal healthcare for older people is mainly carried out by staff lacking academic education, reg. HCP are key actors to bring in and consolidate an evidence-based approach in this setting. Developmental evaluation (DE) has been used to evaluate four separate activities in the initial phase. The activities where sequenced in a cumulative design to provide knowledge for further development of adequate tools.ResultsThe cumulative design originally planned did not fit the internal logic of the municipality. Therefore, workflow and pace adjustmen...
BMC health services research, 2014
BackgroundPersons with dementia receive health care and social services from a wide range of professional care providers during the disease trajectory, presenting risks of miscommunication, duplication and/or missed nursing interventions. Accordingly, the aim of this study was to investigate professional care providers¿ views on conditions for best practice in terms of collaboration and improvement needs in the chain of care from early to end-of-life stage for persons with dementia in Sweden.MethodsThe study had a qualitative design based on three focus group interviews. A strategic sample of 23 professional care providers was included. Data were subjected to content analysis based on the three stages of dementia (early, moderate, end-of-life).ResultsThe results were divided into five categories: Diagnosis is a prerequisite for specialized dementia care, Creating routines in the chain of care, Competent staff a prerequisite for high-quality care, Day care facilitates transition in t...
Journal of healthcare leadership, 2022
Background: The Primary care manager plays a vital role in promoting a research culture in the healthcare center. The position involves both the implementation of organizational directives and patient care. The research culture and use of evidence influence each individual healthcare professional and ultimately the quality of patient care. Purpose: To describe primary healthcare managers' understanding of evidence-based practice in the Swedish primary healthcare context and their ability to influence its implementation. Methodology: Qualitative content analysis of data collected in individual interviews. Results: In general, managers expressed a positive view toward the use of evidence in daily practice. However, they were sometimes hesitant about fully implementing evidence-based results. This was mostly attributed to the struggle of balancing finances and allocating sufficient time for staff to keep up with and engage in evidence-based practice. Conclusion: The organizational culture impacts the mind-set of all co-workers including managers. Those managers influenced by traditions and norms may fall into the trap of devaluing the benefit of research and evidence. The inherent feeling of being alone and without guidance in some matters related to evidence-based practice inevitably leads to inconsistency and ambiguity. The use of clinical pathways that constitute one form of evidence has become a substitute for proper, careful, individual investigation, implementation, and evaluation of each patient case. This means that managers experience moral and physical stress when trying to meet organizational, staff, and patient demands. Practice Implication: Awareness of managers' influence and experience of working according to evidence-based practice is valuable to gain an insight into how Swedish primary healthcare functions at local level. Illuminating and discussing evidencebased practice is an assurance of quality that contributes to many aspects of the overall safety of care.
Quality Management in Health Care
While coaching and customer involvement can enhance the improvement of health and social care, many organizations struggle to develop their improvement capability; it is unclear how best to accomplish this. We examined one attempt at training improvement coaches. The program, set in the Esther Network for integrated care in rural Jönköping County, Sweden, included eight 1-day sessions spanning 7 months in 2011. A senior citizen joined the faculty in all training sessions. Aiming to discern which elements in the program were essential for assuming the role of improvement coach, we used a case-study design with a qualitative approach. Our focus group interviews included 17 informants: 11 coaches, 3 faculty members, and 3 senior citizens. We performed manifest content analysis of the interview data. Creating will, ideas, execution, and sustainability emerged as crucial elements. These elements were promoted by customer focus-embodied by the senior citizen trainer-shared values and a solution-focused approach, by the supportive coach network and by participants' expanded systems understanding. These elements emerged as more important than specific improvement tools and are worth considering also elsewhere when seeking to develop improvement capability in health and social care organizations.
Implementing a continuum of care model for older people-results from a Swedish case study
International journal of integrated care, 2011
There is a need for integrated care and smooth collaboration between care-providing organisations and professions to create a continuum of care for frail older people. However, collaboration between organisations and professions is often problematic. The aim of this study was to examine the process of implementing a new continuum of care model in a complex organisational context, and illuminate some of the challenges involved. The introduced model strived to connect three organisations responsible for delivering health and social care to older people: the regional hospital, primary health care and municipal eldercare. The actions of the actors involved in the process of implementing the model were understood to be shaped by the actors' understanding, commitment and ability. This article is based on 44 qualitative interviews performed on four occasions with 26 key actors at three organisational levels within these three organisations. The results point to the importance of paying...
Evidence‐based practice and determinants of research use in elderly care in Sweden
Journal of Evaluation in Clinical Practice, 2007
Rationale and objective Evidence‐based practice is a strategic ingredient in today’s health care. Despite extensive efforts to produce and disseminate clinical guidelines, research uptake is still a difficult task. In Sweden, elderly care (EC) has shifted from hospital care to community‐based care, and the major nursing‐staff group in EC has no university education. These and other factors make implementation of evidence‐based care particularly challenging in EC settings. The purpose of this study was to identify determinants of research utilization in EC. Method Two questionnaires that cover research utilization and organizational climate were mailed to all staff (n = 132) working in seven EC units. The response rate was 67%. Results Of all respondents, 28% reported that they used research findings in daily practice (the RU group). Remaining respondents constituted the non‐RU group. Significant differences existed between the RU group and the non‐RU group as per six individual a...
Background: From a management point of view, there are many different approaches from which to choose to engage staff members in initiatives to improve performance. Objective: The present study evaluated how two different types of improvement strategies facilitate and encourage involvement of different professional groups in healthcare organizations. Methods/design: Empirical data of two different types of strategies were collected within an improvement project in a County Council in Sweden. The data analysis was carried out through classifying the participants' profession, position, gender, and the organizational administration of which they were a part, in relation to their participation. Setting: An improvement project in a County Council in Sweden. Participants: Designed Improvement Processes consisted of n=105 teams and Intrapreneurship Projects of n=202 projects. Intervention: Two different types of improvement strategies, Designed Improvement Processes and Intrapreneurship Projects. Main Outcome Measures: How two different types of improvement strategies facilitate and encourage involvement of different professional groups in healthcare organizations. Results: Nurses were the largest group participating in both improvement initiatives. Physicians were also well represented, although they seemed to prefer the less structured Intrapreneurship Projects approach. Assistant nurses, being the second largest staff group, were Strengthen Your Relationship Enhance Your Time Efficiency View publication stats View publication stats
Organizing integrated care for older persons : strategies in Sweden
2014
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Organizing integrated care for older persons: strategies in Sweden during the past decade
Journal of health organization and management, 2015
Purpose - The purpose of this paper is to describe and analyse ways of organizing integrated care for older persons in Sweden during the past decade. Design/methodology/approach - The data consist of 62 cases of development work, described in official reports. A meta-analysis of cases was performed, including content analysis of each case. A theoretical framework comprising different forms of integration (co-ordination, contracting, co-operation and collaboration) was applied. Findings - Co-operation was common and collaboration, including multiprofessional teamwork, was rare in the cases. Contracting can be questioned as being a form of integration, and the introduction of consumer choice models appeared problematic in inter-organization integration. Goals stated in the cases concerned steering and designing care, rather than outcome specifications for older persons. Explicit goals to improve integration in itself could imply that the organizations adapt to strong normative expecta...
BMC health services research, 2015
In Central Norway a generic care pathway was developed in collaboration between general hospitals and primary care with the intention of implementing it into everyday practice. The care pathway targeted elderly patients who were in need of home care services after discharge from hospital. The aim of the present study was to investigate the implementation process of the care pathway by comparing the experiences of health care professionals and managers in home care services between the participating municipalities. This was a qualitative comparative process evaluation using data from individual and focus group interviews. The Normalization Process Theory, which provides a framework for understanding how a new intervention becomes part of normal practice, was applied in our analysis. In all of the municipalities there were expectations that the generic care pathway would improve care coordination and quality of follow-up, but a substantial amount of work was needed to make the regular...