Svante Lifvergren

I dag fyller han 90 ar, den outtrottlige filosofen och sociologen Jurgen Habermas. Som en av var tids storsta tankare har han skrivit och debatterat i over 60 ar – alltid beredd att omprova sin egen standpunkt. Vad hade han tyckt om den svenska sjukvardsdebatten?

Currently, health research increasingly involves diverse groups of stakeholders. Such collaborations occur on various levels, where in some cases, stakeholders become co-researchers. However, these stakeholders (e.g. patients) are not always trained in the necessary research skills. On the other hand, researchers are not trained to collaborate with stakeholders. While there is agreement that skill training should be offered as an integral part of participatory health, so far knowledge is lacking on what such a training should look like. This workshop aims to collect experiences from those who have either previously implemented stakeholder skill training or have experiences where stakeholder skill training was lacking but would have been beneficial, and facilitate the exchange of ideas between participants who are interested in the topic. The outcomes will be communicated in ways that are accessible for academic and non-academic stakeholders and will provide them with guidance for conducting stakeholder skill training.

This document focuses on the most relevant needs and characteristics of elderly people affected by mild Cognitive Impairment and mild dementia and helps tracing all the most significant requirements that will have to be taken into consideration during development and pilot projects of the overall initiative. The patient needs and caregiver requirements are batched in clusters, associated to the assistance, support and care needs.

This deliverable aims to define the target population of the DECI Project, by giving the general definitions and boundaries that will be used during the Project, as well as specifying the variables and tests that will be used to analyze the target population in the different pilot sites and, then, subdivide it into various clusters. In particular, the DECI Minimum Data Set (MDS) is defined representing the minimum set of instruments (tests, scales, questionnaires, etc) needed for describing the target population during the pilot phase. MDS is used to standardize the data that each clinical Partner will collect during the pilot phase in order to allow comparisons across the test sites. Finally, the last paragraph includes a preliminary analysis of the target population in the four pilot sites.

New Public Management (NPM) is increasingly used pejoratively and claimed unfit for the complex challenges in contemporary societies, for example aging population structures and, as a result, increased number of cancer patients. Consequently, post-NPM gains increased attention. Drawing from a longitudinal case in Swedish cancer care, the present article seeks to pinpoint post-NPM in public healthcare practice. It is revealed that some post-NPM aspects are recycled by combining traditional public administration (pre-NPM) and NPM aspects: the former’s re-professionalisation is combined with the latter’s foci on performance measures, decentralisation, and accountability. Other post-NPM aspects are hybridizing typical NPM aspects with new (post-NPM) aspects: for instance, customer-focus is taken further to include the patient’s active participation in co-designing services, and standardization is reinterpreted to concern meeting-places rather than efficiency. Yet other aspects are repla...

INTRODUCTION Warfarin is an oral anticoagulant (blood thinning) medication effective for the prevention and treatment of thromboembolic events in various clinical contexts; see Hylek and Singer (1994), Cannegieter et al. (1995), Odén and Fahlén (2002) and Levine et al. (2004) for more information about warfarin treatment. Since it is an extremely safety-critical medication, patients undergoing warfarin treatment should be monitored frequently by blood testing to ensure that the treatment yields desired results; The International Normalized Ratio (INR) defined by the World Health Organization (WHO) as

1. BACKGROUND The challenges of healthcare today are astronomical –from a patient safety, accessibility and medical quality points of view. More (and more expensive) treatment possibilities are available, the proportion of elderly people in the population is growing, people’s awareness of the curing possibilities is increasing and, as a consequence, the cost of healthcare is also increasing. Not until recently the potential of utilising concepts from the quality movement has been recognised in healthcare. Although some early insights have been voiced, see e.g. [Curing healthcare] it is not until the nineties an awareness of the possibilities offered by the industrial quality movement has been realised. In Sweden, a wave of new quality improvement initiatives has started to come into sight during the last years. A typical case is the Skaraborg Hospital Group, where since 2003 systematic quality initiatives have been taken. The Skaraborg Hospital Group, (SkaS), is situated in the West...

This paper focuses on the meeting between a Swedish healthcare organization and the idea of process management. It is evident that the organization itself in many ways becomes an obstacle to the achievement of a process oriented management style. The empirical story that gives voices from the healthcare staff reveals conflicts about the organizing principle and structures such as budgeting and reimbursement systems - obviously built on a more functional view of an organization. It is not completely evident that the two alternative perspectives are easily able to co-exist, and managing seems to be an advanced balancing act.

BACKGROUND Value is one of the central concepts in healthcare, but it is vague within the field of summative eHealth evaluations. Moreover, the role of context in explaining the value is underexplored, and there is no explicit framework guiding the evaluation of value of eHealth interventions. Hence, different studies conceptualize and operationalize value in different ways. OBJECTIVE To identify contextual factors that determined similarities and differences in the value of an eHealth intervention between two contexts. Also, to reflect on and contribute to the discussion about the specification, assessment and relativity of the ‘value’ concept in the evaluation of eHealth interventions. METHODS The study concerned a six-month eHealth intervention targeted at elderly patients (n=107) diagnosed with cognitive impairment in Italy and Sweden. The intervention introduced a case manager role and an eHealth platform to provide remote monitoring and coaching services to the patients. A mod...

Sökning: onr:"swepub:oai:services.scigloo.org:95193" > Design for Six Sigm... ... Gremyr, Ida, 1975-(författare) Chalmers tekniska högskola, Institutionen för teknikens ekonomi och organisation, Industriell kvalitetsutveckling Chakhunashvili, Alexander, 1974-(författare) ...

ABSTRACT The Hospital Group of Skaraborg (SkaS) is situated in the Western Region of Sweden and serves a population of 260 000. The group consists of four hospitals – the hospitals of Lidköping, Skövde, Mariestad and Falköping. The services offered by SkaS include acute and planned care in a large number of specialties. In total there are more than 700 beds and around 4700 employees at SkaS. SkaS shares its responsibility together with the local authorities and the primary care units for the entire health care chain of integrated care. The Skaraborg Hospital Group has recently started a wave of systematic quality initiatives of which this study is one. Others include i.e. the safety of the warfarin treatment process and other topics which are mostly driven by industry evolved Six Sigma techniques. The first signs of the significant role of medical errors emerged with the Harvard Medical Practice Study in 1991. The number of unnecessary deaths owing to iatrogenic injury in the United States was estimated to be equivalent to 3 jumbo jet crashes every 2 days. In the report “Error in medicine” (1994) Lucian Leape, a pediatric surgeon and patient safety pioneer came to the conclusion that there are significant parallels between human error science and medical errors: medical errors were seldom caused by irresponsible or unprepared individuals, but rather intrinsic to the system we work in. He stated, “All humans err frequently. Systems that rely on error-free performance are doomed to fail”. In 1998 the Institute of Medicine (IOM) published its 1998 report, “To Err is Human.” which concluded that between 44,000 and 98,000 Americans die annually from medical mistakes. The report estimated the cost of injury to be between $17 and $29 billion annually, over half of which was the direct cost of treating injury. The response was the creation of both voluntary and mandatory error reporting systems. Hospitals started to form patient safety agendas. In 2001 the IOM published a second medical error analysis, “Crossing the Quality Chasm,” thus the conclusion was that big improvements were not seen yet and it suggested that “environments have to be created that foster and reward improvement by (1) creating an infrastructure to support evidence-based practice, (2) facilitating the use of information technology, (3) aligning payment incentives, and (4) preparing the workforce to better serve patients in a world of expanding knowledge and rapid change”. In Sweden the National Board of Health and Welfare estimated a number 150 of such cases in 2003 and a number of preventable non-fatal adverse events of around 30.500 per year. Unintended and severe medical errors are common in the complex area of pharmaceutical treatment. The Swedish National Board of Health and Welfare estimates that about 10% of all treatment time for hospitalized patients in internal medicine clinics are due to wrong pharmaceutical treatment. These so called adverse drug events (ADE) are in many cases preventable and have the potential to be reduced significantly. Studies show that serious ADEs are likely to prevent with information technology in certain key processes i.e. ordering by checking known information about the patient (allergies, bidiagnosis, etc.) against known information about the drugs intended for treatment, which often is a very complex process and prone to errors. In order to reward improvement, it is necessary to focus further research on medical errors in interaction with human behavior, error reporting systems and how close they are to reality. Quality measurement of overall service is needed in order to discover the right relations between these three fields and to leave the grounds of assumptions. This study is a step towards that aim. In order to reach measurable improvements in service, the Six Sigma initiative, which first launched by Motorola 20 years ago and is today used by companies such as ABB, Kodak, General Electric, Siemens, Toshiba, NEC, Motorola, Ericsson and Samsung, gives us the tools required. The main goal of Six Sigma is to optimize the performance of processes. Putting the focus on error reduction in medical treatment processes, Six Sigma delivers possibilities to eliminate defects in process outcome through identification and control of variation in processes. The aim is to identify factors and root causes of hazardous processes and to redesign the processes in to order to gain safe, stable and predictable results. Six Sigma defines ultra high-quality manufacturing systems, in which only 3.4 defects occur per 1 million opportunities, a nearly perfect production rate of 99.9997%. Today most of businesses reach the level of three or two Sigma, meaning a defect rate between 65,807 and 308,530 defects per 1 million opportunities. It has been estimated that healthcare is unlikely to become better than three Sigma. Six Sigma has two key methodologies: DMAIC and DMADV. DMAIC (Define - Measure - Analyze - Improve -…

Purpose – The purpose of this paper is to study critical practices when adopting improvement knowledge as a management innovation in a professional organization. Design/methodology/approach – This paper is based on an action research approach, in which practitioners and researchers are seen as a part of a participative community generating actionable knowledge. Research involved gathering data over a five-year period through more than 250 interviews and 25 focus groups. Findings – This paper identifies five critical practices for adopting a management innovation in a professional context: first, focussing on labeling and theorizing to create an organization’s own vocabulary; second, focussing on the role of internal change agents; third, allowing for an evolutionary adoption process; fourth, building new professional competence through the change agents; and fifth, adopting a research-driven approach to the adoption of a management innovation. Practical implications – For healthcare...