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  • 1.
    Aarons, G. A.
    et al.
    University of California, United States.
    Seijo, C.
    University of California, United States.
    Green, A. E.
    University of California, United States.
    Moullin, J. C.
    Curtin University, Perth, Australia.
    Hasson, H.
    Karolinska Institutet, Stockholm, Sweden.
    von Thiele Schwarz, Ulrica
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Karolinska Institutet, Stockholm, Sweden.
    James, S.
    University of Kassel, Kassel, Germany.
    Ehrhart, M. G.
    University of Central Florida, Orlando, Florida.
    Ducarroz, S.
    Université Claude Bernard, Lyon, France.
    Sevdalis, N.
    King's College London, UK.
    Willging, C.
    Behavioral Health Research Center of the Southwest, Albuquerque, United States.
    Fostering international collaboration in implementation science and research: A concept mapping exploratory study2019Ingår i: BMC Research Notes, ISSN 1756-0500, E-ISSN 1756-0500, Vol. 12, nr 1, artikel-id 778Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: International collaboration in science has received increasing attention given emphases on relevance, generalizability, and impact of research. Implementation science (IS) is a growing discipline that aims to translate clinical research findings into health services. Research is needed to identify efficient and effective ways to foster international collaboration in IS. Concept-mapping (CM) was utilized with a targeted sample for preliminary exploration of fostering international collaboration. Concept-mapping is a mixed-method approach (qualitative/quantitative) particularly suited for identifying essential themes and action items to facilitate planning among diverse stakeholders. We sought to identify key factors likely to facilitate productive and rewarding international collaborations in implementation research. Results: We identified eleven dimensions: Strategic Planning; Practicality; Define Common Principles; Technological Tools for Collaboration; Funding; Disseminate Importance of Fostering International Collaboration in IS; Knowledge Sharing; Innovative & Adaptive Research; Training IS Researchers; Networking & Shared Identity; Facilitate Meetings. Strategic Planning and Funding were highest rated for importance and Strategic Planning and Networking and Shared Identity were rated most feasible to institute. Fostering international collaboration in IS can accelerate the efficiency, relevance, and generalizability of implementation research. Strategies should be developed and tested to improve international collaborations and engage junior and experienced investigators in collaborations advancing implementation science and practice. 

  • 2.
    Aarons, Gregory
    et al.
    Univ Calif San Diego, La Jolla, CA 92093 USA.;Child & Adolescent Serv Res Ctr, San Diego, CA USA..
    Green, Amy
    Univ Calif San Diego, La Jolla, CA 92093 USA..
    Moullin, Joanna
    Univ Calif San Diego, La Jolla, CA 92093 USA.;Univ Technol Sydney, Sydney, NSW, Australia..
    Ehrhart, Mark
    San Diego State Univ, San Diego, CA 92182 USA.;Univ Cent Florida, Orlando, FL 32816 USA..
    Ducarroz, Simon
    Ctr Reg Prevent Canc, Ctr Hygee, St Priest En Jarez, France..
    Sevdalis, Nick
    Kings Coll London, London, England..
    Hasson, Henna
    Karolinska Inst, Stockholm, Sweden.;Stockholm Cty Council, Ctr Epidemiol & Community Med, Stockholm, Sweden..
    von Thiele Schwarz, Ulrica
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Karolinska Inst, Stockholm, Sweden.
    James, Sigrid
    Univ Kassel, Kassel, Germany..
    Willging, Cathleen
    Pacific Inst Res & Evaluat, Behav Hlth Res Ctr Southwest, Albuquerque, NM USA..
    Fostering international collaborations in implementation science2018Ingår i: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 13Artikel i tidskrift (Övrigt vetenskapligt)
  • 3.
    Abildgaard, J. S.
    et al.
    National Research Centre for the Working Environment, Denmark, Denmark.
    Hasson, H.
    Karolinska Institutet, Sweden.
    von Thiele Schwarz, Ulrica
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Løvseth, L. T.
    St Olavs University Hospital, Norway.
    Ala-Laurinaho, A.
    Finnish Institute of Occupational Health, Finland, Finland.
    Nielsen, K.
    University of Sheffield, UK, United Kingdom.
    Forms of participation: The development and application of a conceptual model of participation in work environment interventionsIngår i: Economic and Industrial Democracy, ISSN 0143-831X, E-ISSN 1461-7099Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In the realm of work environment improvements, the Nordic countries have led the way in demonstrating that employee participation is a key requisite for achieving improvements. Despite this, there is a lack of precision as to what ‘participatory’ in a participatory work environment intervention means. In this study, the authors present a conceptual model for participation in work environment interventions and apply it to protocols and manuals from eight participatory interventions to determine the form of participation used in each intervention. The authors suggest that the conceptual model can be applied in the design and assessment of participatory work environment interventions. 

  • 4.
    Astnell, Sandra
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    von Thiele Schwarz, Ulrica
    Karolinska Institutet.
    Hasson, Henna
    Karolinska Institutet, Stockholm, Sweden.
    Augustsson, Hanna
    Karolinska Institutet, Stockholm, Sweden.
    Stenfors-Hayes, Terese
    Karolinska Institutet, Stockholm, Sweden.
    Integrating health promotion with quality improvement in a Swedish hospital2015Ingår i: Health Promotion International, ISSN 0957-4824, E-ISSN 1460-2245, Vol. 31, nr 3, s. 495-504Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Integration of workplace employee health promotion (HP) and occupational health and safety (OHS) work into organizational quality improvement systems is suggested as a way to strengthen HP and OHS activities in an organization. The aim of this article was to study what consequences integration of HP, OHS and a quality improvement system called kaizen has on the frequency and type of HP and OHS activities. A quasi-experimental study design was used where an integration of the three systems for HP, OHS respectively kaizen, was performed at six intervention units at a Swedish hospital. The remaining six units served as controls. Document analysis of all employees' written improvement suggestions (kaizen notes) during 2013 was conducted. The findings show that the intervention group had more suggestions concerning HP and OHS (n = 114) when compared with the control group (n = 78) and a greater variety of HP and OHS suggestions. In addition, only the intervention group had included HP aspects. In both groups, most kaizen notes with health consideration had a preventive focus rather than rehabilitative. The intervention, i.e. the integration of HP, OHS and kaizen work, had a favourable effect on HP and OHS work when compared with the controls. The results of the study support that this system can work in practice at hospitals.

  • 5.
    Athlin, A. Muntlin
    et al.
    Uppsala Univ, Uppsala, Sweden.;Univ Adelaide, Adelaide, SA 5005, Australia..
    Farrokhnia, N.
    Karolinska Inst, S-10401 Stockholm, Sweden..
    von Thiele Schwarz, Ulrica
    Karolinska Inst, S-10401 Stockholm, Sweden.;Stockholm Univ, Stockholm, Sweden..
    Introduction of multi-professional teamwork: a promising approach towards a more patient-centred care in the emergency department2014Ingår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 22, nr 4, s. 274-275Artikel i tidskrift (Övrigt vetenskapligt)
  • 6. Athlin, Muntlin Å
    et al.
    Farrokhnia, N
    von Thiele Schwarz, Ulrica
    Mälardalens högskola, Akademin för hälsa, vård och välfärd. Karolinska Institutet, Sweden.
    Teamwork in the emergency department-a systematic evaluation of a new working routine2011Konferensbidrag (Refereegranskat)
  • 7.
    Augustsson, H.
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    von Thiele Schwarz, Ulrica
    Karolinska Institutet, Stockholm, Sweden; Stockholm University, Stockholm, Sweden.
    Stenfors-Hayes, T.
    Karolinska Institutet, Stockholm, Sweden.
    Hasson, H.
    Karolinska Institutet, Stockholm, Sweden.
    Investigating Variations in Implementation Fidelity of an Organizational-Level Occupational Health Intervention2015Ingår i: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 22, nr 3, s. 345-355Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The workplace has been suggested as an important arena for health promotion, but little is known about how the organizational setting influences the implementation of interventions. Purpose: The aims of this study are to evaluate implementation fidelity in an organizational-level occupational health intervention and to investigate possible explanations for variations in fidelity between intervention units. Method: The intervention consisted of an integration of health promotion, occupational health and safety, and a system for continuous improvements (Kaizen) and was conducted in a quasi-experimental design at a Swedish hospital. Implementation fidelity was evaluated with the Conceptual Framework for Implementation Fidelity and implementation factors used to investigate variations in fidelity with the Framework for Evaluating Organizational-level Interventions. A multi-method approach including interviews, Kaizen notes, and questionnaires was applied. Results: Implementation fidelity differed between units even though the intervention was introduced and supported in the same way. Important differences in all elements proposed in the model for evaluating organizational-level interventions, i.e., context, intervention, and mental models, were found to explain the differences in fidelity. Conclusion: Implementation strategies may need to be adapted depending on the local context. Implementation fidelity, as well as pre-intervention implementation elements, is likely to affect the implementation success and needs to be assessed in intervention research. The high variation in fidelity across the units indicates the need for adjustments to the type of designs used to assess the effects of interventions. Thus, rather than using designs that aim to control variation, it may be necessary to use those that aim at exploring and explaining variation, such as adapted study designs. 

  • 8.
    Augustsson, Hanna
    et al.
    Karolinska Institutet, Sweden.
    Richter, Anne
    Karolinska Institutet, Sweden.
    Hasson, Henna
    Karolinska Institutet, Sweden.
    von Thiele Schwarz, Ulrica
    Karolinska Institutet, Sweden.
    The Need for Dual Openness to Change: A Longitudinal Study Evaluating the Impact of Employees’ Openness to Organizational Change Content and Process on Intervention Outcomes2017Ingår i: Journal of Applied Behavioral Science, ISSN 0021-8863, E-ISSN 1552-6879, Vol. 53, nr 3, s. 349-368Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study investigates how individual- and group-level openness to organizational change, concerning change content and process, affects intervention outcomes. The intervention aimed to improve primary health care employees' competence in and use of information and communication technologies (ICT). Employees' (n = 1,042) ratings of their openness to the change content and process as well as of their workgroup's openness to the change content before the intervention were used to predict ICT competence and its use 18 months later. Openness to the change process predicted both ICT competence and use of competence, while openness to the change content and group openness predicted use of competence only. These results show that individual- and group-level openness to organizational change are important predictors of successful outcomes. Furthermore, employees should be open both to the content of the change and to the process by which the intervention is implemented in order to maximize outcomes.

  • 9.
    Bergman, D.
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Lornudd, C.
    Karolinska Institutet, Stockholm, Sweden.
    Sjöberg, L.
    Stockholm School of Economics, Stockholm, Sweden.
    von Thiele Schwarz, Ulrica
    Karolinska Institutet, Stockholm, Sweden.
    Leader personality and 360-degree assessments of leader behavior2014Ingår i: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 55, nr 4, s. 389-397Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    To investigate the relationship between personality and multi-source feedback, we assessed 190 health care managers by applying the Understanding Personal Potential personality test, which provides comprehensive measurement of the Big Five dimensions and eight narrower personality traits. Managers' leadership behaviors were assessed by colleagues, supervisors, a random sample of each manager's subordinates as well as the managers themselves using a 360-degree change, production, employee (CPE) instrument. Hierarchical multivariate regression analysis showed that the Big Five variables were significantly related to the Managers' leadership behavior in all CPE dimensions. Also, addition of narrow personality variables to the Big Five increased explained variance in leadership behavior. This study is the first of its kind to include the full range of viewpoints in a 360-degree instrument, along with a large number of subordinate assessments. We found that both the strength of the relationship between personality and behavior and the configuration of different predictors varied depending on who did the rating and what leadership orientation was investigated, and this observation merits further investigation. 

  • 10.
    Bäck, A.
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Ståhl, C.
    Linköping University, Linköping, Sweden.
    von Thiele Schwarz, Ulrica
    Karolinska Institutet, Stockholm, Sweden.
    Richter, A.
    Karolinska Institutet, Stockholm, Sweden.
    Hasson, H.
    Karolinska Institute, Stockholm, Sweden.
    Walking the tightrope-perspectives on local politicians' role in implementing a national social care policy on evidence-based practice2016Ingår i: International Journal of Mental Health Systems, ISSN 1752-4458, E-ISSN 1752-4458, Vol. 10, nr 1, artikel-id 75Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Despite national policy recommending evidence-based practice (EBP), its application in social care has been limited. While local politicians can affect the process, little is known about their knowledge, attitudes and roles regarding EBP. The aim here is twofold: to explore the role of local politicians in the implementation of EBP in social care from both their own and a management perspective; and to examine factors politicians perceive as affecting their decisions and actions concerning the implementation of EBP policy. Methods: Local politicians (N=13) and managers (N=22) in social care were interviewed. Qualitative thematic analysis with both inductive and deductive codes was used. Results: Politicians were rather uninformed regarding EBP and national policy. The factors limiting their actions were, beside the lack of awareness, lack of ability to question existing working methods, and a need for support in the steering of EBP. Thus, personal interest played a significant part in what role the politicians assumed. This resulted in some politicians taking a more active role in steering EBP while others were not involved. From the managers' perspective, a more active steering by politicians was desired. Setting budget and objectives, as well as active follow-up of work processes and outcomes, were identified as means to affect the implementation of EBP. However, the politicians seemed unaware of the facilitating effects of these actions. Conclusions: Local politicians had a possibility to facilitate the implementation of EBP, but their role was unclear. Personal interest played a big part in determining what role was taken. The results imply that social care politicians might need support in the development of their steering of EBP. Moving the responsibility for EBP facilitation upwards in the political structure could be an important step in developing EBP in social care. 

  • 11.
    Bäck, Annika
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    von Thiele Schwarz, Ulrica
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Karolinska Institutet, Stockholm, Sweden.
    Hasson, Henna
    Karolinska Institutet, Stockholm, Sweden.
    Richter, Anne
    Karolinska Institutet, Stockholm, Sweden.
    Aligning Perspectives?: Comparison of Top and Middle-Level Managers’ Views on How Organization Influences Implementation of evidence-based practiceIngår i: British Journal of Social Work, ISSN 0045-3102, E-ISSN 1468-263XArtikel i tidskrift (Refereegranskat)
    Abstract [en]

    A supportive organizational context is important for successfully implementing evidence-based practice (EBP). Managers have an important role in creating organizational prerequisites for EBP. The present study compared how top- and middle-level managers describe the process of implementing EBP and the factors influencing this process. Data were collected through interviews with twenty-two managers in social services, and analysed with thematic deductive analysis based on the Theoretical Domains Framework (TDF) and the COM-B model. Findings showed that top-level managers focused more on strategic- and system-level issues, e.g. external comparisons, dialogue with authorities and creating support systems, while the middle managers focused on the operative implementation at staff level, i.e. motivating and involving staff. Furthermore, the two groups had different understandings of EBP. To conclude, there needs to be an alignment in the understanding of, and support for, EBP between the different levels of managers. To create a mutual understanding of what EBP entails and to clearly communicate how the organization applies the different steps of the EBP process could be crucial steps in enabling the implementation of EBP, and needs to be done in dialogue between middle- and top-level managers.

  • 12.
    Eib, Constanze
    et al.
    Stockholm Univ, Dept Psychol, Stockholm, Sweden..
    von Thiele Schwarz, Ulrica
    Stockholm Univ, Dept Psychol, Stockholm, Sweden.;Karolinska Inst, Dept Learning Informat Management & Eth, Med Management Ctr, S-10401 Stockholm, Sweden..
    Blom, Victoria
    Karolinska Inst, Dept Clin Neurosci, Insurance Med, S-10401 Stockholm, Sweden.;Swedish Sch Sport & Hlth Sci, Dept Phys Act & Hlth, Stockholm, Sweden..
    Don't Let It Get to You! A Moderated Mediated Approach to the (In)Justice-Health Relationship2015Ingår i: Journal of Occupational Health Psychology, ISSN 1076-8998, E-ISSN 1939-1307, Vol. 20, nr 4, s. 434-445Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The present study investigates the consequences of overall justice perceptions on employees' mental health and work-family conflict. While many studies have found that perceiving injustice at work is harmful, little is known about the underlying processes. Based on the allostatic load model, it is hypothesized that mental preoccupation with work, defined as a cognitive state, is a mediator linking overall justice perceptions to employee health. Moreover, we argue that locus of control is a moderator for the mediated relationship. We tested our hypotheses with panel data consisting of 412 Swedish office workers. Results support that mental preoccupation with work mediates the relationship between overall justice and mental health, and overall justice and work-family conflict. Results also reveal that mental preoccupation with work plays a greater mediating role for individuals with an external locus of control. Implications and suggestions for future studies on the emerging relationship between organizational justice and health are discussed.

  • 13.
    Forsberg, H. H.
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Athlin, T. M.
    Uppsala University, Uppsala, Sweden.
    von Thiele Schwarz, Ulrica
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Karolinska Institutet, Stockholm, Sweden; Stockholm University, Stockholm, Sweden.
    Nurses' perceptions of multitasking in the emergency department: Effective, fun and unproblematic (at least for me) - a qualitative study2015Ingår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 23, nr 2, s. 59-64Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: The aim was to understand how multitasking is experienced by registered nurses and how it relates to their everyday practice in the emergency department. Method: Interviews with open-ended questions were conducted with registered nurses (n = 9) working in one of two included emergency departments in Sweden. Data were analyzed using Schilling's structured model for qualitative content analysis. Results: Three core concepts related to multitasking emerged from the interviews: 'multitasking - an attractive prerequisite for ED care'; 'multitasking implies efficiency' and 'multitasking is not stressful'. From these core concepts an additional theme emerged: '. and does not cause errors - at least for me', related to patient safety. Discussion: This study shows how the patient load and the unreflected multitasking that follows relate to nurses' perceived efficiency and job satisfaction. It also shows that the relationship between multitasking and errors is perceived to be mediated by whom the actor is, and his or her level of experience. Findings from this study add value to the discourse on multitasking and the emergency department context, as few studies go beyond examining the quantitative aspect of interruptions and multitasking and how it is experienced by the staff in their everyday practice.

  • 14.
    Frykman, M.
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Hasson, H.
    Karolinska Institutet, Stockholm, Sweden.
    Muntlin Athlin, A.
    University of Adelaide, Adelaide, Australia.
    von Thiele Schwarz, Ulrica
    Karolinska Institutet, Stockholm, Sweden.
    Functions of behavior change interventions when implementing multi-professional teamwork at an emergency department: A comparative case study2014Ingår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 14, nr 1, artikel-id 218Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    While there is strong support for the benefits of working in multi-professional teams in health care, the implementation of multi-professional teamwork is reported to be complex and challenging. Implementation strategies combining multiple behavior change interventions are recommended, but the understanding of how and why the behavior change interventions influence staff behavior is limited. There is a lack of studies focusing on the functions of different behavior change interventions and the mechanisms driving behavior change. In this study, applied behavior analysis is used to analyze the function and impact of different behavior change interventions when implementing multi-professional teamwork. Methods. A comparative case study design was applied. Two sections of an emergency department implemented multi-professional teamwork involving changes in work processes, aimed at increasing inter-professional collaboration. Behavior change interventions and staff behavior change were studied using observations, interviews and document analysis. Using a hybrid thematic analysis, the behavior change interventions were categorized according to the DCOM® model. The functions of the behavior change interventions were then analyzed using applied behavior analysis. Results: The two sections used different behavior change interventions, resulting in a large difference in the degree of staff behavior change. The successful section enabled staff performance of teamwork behaviors with a strategy based on ongoing problem-solving and frequent clarification of directions. Managerial feedback initially played an important role in motivating teamwork behaviors. Gradually, as staff started to experience positive outcomes of the intervention, motivation for teamwork behaviors was replaced by positive task-generated feedback. Conclusions: The functional perspective of applied behavior analysis offers insight into the behavioral mechanisms that describe how and why behavior change interventions influence staff behavior. The analysis demonstrates how enabling behavior change interventions, managerial feedback and task-related feedback interact in their influence on behavior and have complementary functions during different stages of implementation. 

  • 15.
    Frykman, M.
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Lundmark, R.
    Karolinska Institutet, Stockholm, Sweden.
    von Thiele Schwarz, Ulrica
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Karolinska Institutet, Stockholm, Sweden.
    Villaume, K.
    Karolinska Institutet, Stockholm, Sweden.
    Hasson, H.
    Karolinska Institutet, Stockholm, Sweden.
    Line managers’ influence on employee usage of a web-based system for occupational health management2018Ingår i: International Journal of Workplace Health Management, ISSN 1753-8351, E-ISSN 1753-836X, Vol. 11, nr 4, s. 193-209Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: The purpose of this paper is to investigate line managers’ influence on employee usage of a web-based system for occupational health management. Design/methodology/approach: Questionnaires were used to measure line managers’ transformational leadership at baseline and their change-supportive managerial activities during weeks 16–52. Employee initial (weeks 16–52) and sustained (weeks 53–144) use of the web-based system was measured by extracting their frequency of logins to the system from electronic records. Data were collected from six white-collar organizations from 2011 through 2013. Mixed Poisson regressions were used to analyze the influence of transformational leadership and change-supportive managerial activities on employee usage. Findings: As predicted, line managers’ change-supportive activities influenced the employees’ initial and sustained use of the system. Line managers’ transformational leadership had no direct effect on employees’ use of the system, however transformational leadership was indirectly associated with employees’ initial and sustained use of the system through line managers’ change-supportive activities. Originality/value: The study adds to the understanding of the role line managers’ play during the implementation of occupational health interventions. The findings suggest that the line managers’ change-supportive activities directed toward the intervention are important for employees’ initial and sustained use of the system. The influence of transformational leadership was indirect, suggesting that line managers may need to direct their leadership behaviors toward the intervention to facilitate implementation. © 2018, Emerald Publishing Limited.

  • 16.
    Frykman, Mandus
    et al.
    Karolinska Institutet, Sweden.
    von Thiele Schwarz, Ulrica
    Karolinska Institutet, Sweden.
    Muntlin Athlin, Åsa
    Uppsala Universitet, Sweden.
    Hasson, Henna
    Karolinska Institutet, Sweden.
    Mazzocato, Pamela
    Karolinska Institutet, Sweden.
    The work is never ending: uncovering teamwork sustainability using realistic evaluation2017Ingår i: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 31, nr 1, s. 64-81Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose-The purpose of this paper is to uncover the mechanisms influencing the sustainability of behavior changes following the implementation of teamwork. Design/methodology/approach-Realistic evaluation was combined with a framework (DCOM®) based on applied behavior analysis to study the sustainability of behavior changes two and a half years after the initial implementation of teamworkat an emergency department. The DCOM® framework was used to categorize the mechanisms of behavior change interventions (BCIs) into the four categories of direction, competence, opportunity, and motivation. Non-participant observation and interview data were used. Findings-The teamwork behaviors were not sustained. A substantial fallback in managerial activities in combination with a complex context contributed to reduced direction, opportunity, and motivation. Reduced direction made staff members unclear about how and why they should work in teams. Deterioration of opportunity was evident from the lack of problem-solving resources resulting in accumulated barriers to teamwork. Motivation in terms of management support and feedback was reduced. Practical implications-The implementation of complex organizational changes in complex healthcare contexts requires continuous adaption and managerial activities well beyond the initial implementation period. Originality/value-By integrating the DCOM® framework with realistic evaluation, this study responds to the call for theoretically based research on behavioral mechanisms that can explain how BCIs interact with context and how this interaction influences sustainability.

  • 17.
    Granath, J.
    et al.
    Stockholm University, Sweden.
    Ingvarsson, S.
    Stockholm University, Sweden.
    von Thiele Schwarz, Ulrica
    Stockholm University, Sweden.
    Lundberg, U.
    Stockholm University, Sweden.
    Stress management: A randomized study of cognitive behavioural therapy and yoga2006Ingår i: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 35, nr 1, s. 3-10Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In this study, a stress management program based on cognitive behavioural therapy principles was compared with a Kundaliniyoga program. A study sample of 26 women and 7 men from a large Swedish company were divided randomly into 2 groups for each of the different forms of intervention; a total of 4 groups. The groups were instructed by trained group leaders and 10 sessions were held with each of groups, over a period of 4 months. Psychological (self-rated stress and stress behaviour, anger, exhaustion, quality of life) and physiological (blood pressure, heart rate, urinary catecholamines, salivary cortisol) measurements obtained before and after treatment showed significant improvements on most of the variables in both groups as well as medium-to-high effect sizes. However, no significant difference was found between the 2 programs. The results indicate that both cognitive behaviour therapy and yoga are promising stress management techniques.

  • 18.
    Hasson, D.
    et al.
    Stockholm University, Sweden.
    von Thiele Schwarz, Ulrica
    Stockholm University, Sweden.
    Lindfors, P.
    Stockholm University, Sweden.
    Erratum: Self-rated health and allostatic load in women working in two occupational sectors (Journal of Health Psychology (2009) 14:4 (568-577) DOI: 10.1177/1359105309103576)2011Ingår i: Journal of Health Psychology, ISSN 1359-1053, E-ISSN 1461-7277, Vol. 16, nr 5Artikel i tidskrift (Refereegranskat)
  • 19.
    Hasson, D.
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    von Thiele Schwarz, Ulrica
    Stockholm University, Sweden.
    Lindfors, P.
    Stockholm University, Sweden.
    Self-rated health and allostatic load in women working in two occupational sectors2009Ingår i: Journal of Health Psychology, ISSN 1359-1053, E-ISSN 1461-7277, Vol. 14, nr 4, s. 568-577Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study set out to investigate how biological dysregulation, in terms of allostatic load (AL), relates to self-rated health (SRH) in women. Data on SRH and 12 biomarkers used to assess AL were available for 241 employees from the health care sector and 98 employees from the IT/media sector. In line with the hypothesis, results showed that a poor SRH, along with occupational sector, age and education, were significantly associated with a high AL, particularly for those working within the health care sector. This association between a poor SRH and AL, suggests a link between SRH and biological dysregulation. 

  • 20.
    Hasson, H.
    et al.
    Procome research group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE 171 77, Stockholm, Sweden.
    Nilsen, P.
    Department of Medical and Health Sciences, Division of Community Medicine, Linköping University, Linköping, Sweden.
    Augustsson, H.
    Procome research group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE 171 77, Stockholm, Sweden.
    Ingvarsson, S.
    Procome research group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE 171 77, Stockholm, Sweden.
    Korlén, S.
    Procome research group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE 171 77, Stockholm, Sweden.
    von Thiele Schwarz, Ulrica
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Procome research group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE 171 77, Stockholm, Sweden.
    To do or not to do - Balancing governance and professional autonomy to abandon low-value practices: A study protocol2019Ingår i: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 14, nr 1, artikel-id 70Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Many interventions used in health care lack evidence of effectiveness and may be unnecessary or even cause harm, and should therefore be de-implemented. Lists of such ineffective, low-value practices are common, but these lists have little chance of leading to improvements without sufficient knowledge regarding how de-implementation can be governed and carried out. However, decisions regarding de-implementation are not only a matter of scientific evidence; the puzzle is far more complex with political, economic, and relational interests play a role. This project aims at exploring the governance of de-implementation of low-value practices from the perspectives of national and regional governments and senior management at provider organizations. Methods: Theories of complexity science and organizational alignment are used, and interviews are conducted with stakeholders involved in the governance of low-value practice de-implementation, including national and regional governments (focusing on two contrasting regions in Sweden) and senior management at provider organizations. In addition, an ongoing process for governing de-implementation in accordance with current recommendations is followed over an 18-month period to explore how governance is conducted in practice. A framework for the governance of de-implementation and policy suggestions will be developed to guide de-implementation governance. Discussion: This study contributes to knowledge about the governance of de-implementation of low-value care practices. The study provides rich empirical data from multiple system levels regarding how de-implementation of low-value practices is currently governed. The study also makes a theoretical contribution by applying the theories of complexity and organizational alignment, which may provide generalizable knowledge about the interplay between stakeholders across system levels and how and why certain factors influence the governance of de-implementation. The project employs a solution-oriented perspective by developing a framework for de-implementation of low-value practices and suggesting practical strategies to improve the governance of de-implementation. The framework and strategies can thereafter be evaluated for validity and impact in future studies. 

  • 21.
    Hasson, H.
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Tafvelin, S.
    Umeå Universitet, Umeå, Sweden.
    von Thiele Schwarz, Ulrica
    Karolinska Institutet, Stockholm, Sweden; Stockholm University, Stockholm, Sweden.
    Comparing Employees and Managers' Perceptions of Organizational Learning, Health, and Work Performance2013Ingår i: Advances in Developing Human Resources, ISSN 1523-4223, E-ISSN 1552-3055, Vol. 15, nr 2, s. 163-176Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The Problem. Disagreement between subordinates and their managers' perceptions of organizational climate and support has been related to less efficient work performance and worse organizational outcomes. Possible consequences of disagreement between managers' and subordinates' ratings of organizational learning are currently not known. Little is also known about how the level of agreement between the two ratings relates to employees' performance and wellbeing at work. The Solution. The study was conducted in an industrial company in Sweden. First-line managers' and their subordinates' responses to the Dimensions of the Learning Organization Questionnaire (DLOQ) were evaluated along with employees' ratings of their work performance and health.

  • 22.
    Hasson, H.
    et al.
    Karolinska Institutet, Solna, Sweden.
    Villaume, K.
    Karolinska Institutet, Solna, Sweden.
    von Thiele Schwarz, Ulrica
    Karolinska Institutet, Solna, Sweden.
    Palm, K.
    Karolinska Institutet, Solna, Sweden.
    Managing implementation: Roles of line managers, senior managers, and human resource professionals in an occupational health intervention2014Ingår i: Journal of Occupational and Environmental Medicine, ISSN 1076-2752, E-ISSN 1536-5948, Vol. 56, nr 1, s. 58-65Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE:: To contrast line managersÊ, senior managersÊ, and (human resource) HR professionalsÊ descriptions of their roles, tasks, and possibilities to perform them during the implementation of an occupational health intervention. METHODS:: Interviews with line managers (n = 13), senior managers (n = 7), and HR professionals (n = 9) 6 months after initiation of an occupational health intervention at nine organizations. RESULTS:: The groupsÊ roles were described coherently, except for the HR professionals. These roles were seldom performed in practice, and two main reasons appeared: use of individuals engagement rather than an implementation strategy, and lack of integration of the intervention with other stakeholders and organizational processes. CONCLUSIONS:: Evaluation of stakeholders perceptions of each otherÊs and their own roles is important, especially concerning HR professionals. Clear role descriptions and implementation strategies, and aligning an intervention to organizational processes, are crucial for efficient intervention management.  

  • 23.
    Hasson, H.
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    von Thiele Schwarz, Ulrica
    Karolinska Institutet, Stockholm, Sweden.
    Holmstrom, S.
    Umeå University, Umeå, Swede.
    Karanika-Murray, M.
    Nottingham Trent University, Nottingham, United Kingdom.
    Tafvelin, S.
    Umeå Universitet, Umeå, Sweden.
    Improving organizational learning through leadership training2016Ingår i: Journal of Workplace Learning, ISSN 1366-5626, E-ISSN 1758-7859, Vol. 28, nr 3, s. 115-129Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose – This paper aims to evaluate whether training of managers at workplaces can improve organizational learning. Managers play a crucial role in providing opportunities to employees for learning. Although scholars have called for intervention research on the effects of leadership development on organizational learning, no such research is currently available. Design/methodology/approach – The training program consisted of theoretical and practical elements aimed to improve line managers’ transformational leadership behaviors and, in turn, improve organizational learning. The study used a pre- and post-intervention evaluation survey. Line managers’ and their subordinates’ perceptions of organizational learning were measured with the Dimensions of Organizational Learning Questionnaire and with post-intervention single items on organizational learning. Findings – Comparisons between pre- and post-intervention assessments revealed that managers’ ratings of continuous learning and employees’ ratings of empowerment and embedded systems improved significantly as a result of the training. The leadership training intervention had positive effects on managers’ perceptions of individual-level and on employees’ perceptions of organizational-level aspects of organizational learning. Originality/value – The study provides empirical evidence that organizational learning can be improved through leadership training. Both line managers and their subordinates perceived that organizational learning had increased after the training intervention, albeit in different ways. Implications for developing leadership training programs and for evaluating these are discussed. 

  • 24.
    Hasson, H.
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    von Thiele Schwarz, Ulrica
    Karolinska Institutet, Stockholm, Sweden; Stockholm University, Stockholm, Sweden.
    Nielsen, K.
    Norwich Business School, University of East Anglia, Norwich, United Kingdom.
    Tafvelin, S.
    Umeå University, Umeå, Sweden.
    Are We All in the Same Boat?: The Role of Perceptual Distance in Organizational Health Interventions2016Ingår i: Stress and Health, ISSN 1532-3005, E-ISSN 1532-2998, Vol. 32, nr 4, s. 294-303Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The study investigates how agreement between leaders' and their team's perceptions influence intervention outcomes in a leadership-training intervention aimed at improving organizational learning. Agreement, i.e. perceptual distance was calculated for the organizational learning dimensions at baseline. Changes in the dimensions from pre-intervention to post-intervention were evaluated using polynomial regression analysis with response surface analysis. The general pattern of the results indicated that the organizational learning improved when leaders and their teams agreed on the level of organizational learning prior to the intervention. The improvement was greatest when the leader's and the team's perceptions at baseline were aligned and high rather than aligned and low. The least beneficial scenario was when the leader's perceptions were higher than the team's perceptions. These results give insights into the importance of comparing leaders' and their team's perceptions in intervention research. Polynomial regression analyses with response surface methodology allow three-dimensional examination of relationship between two predictor variables and an outcome. This contributes with knowledge on how combination of predictor variables may affect outcome and allows studies of potential non-linearity relating to the outcome. Future studies could use these methods in process evaluation of interventions. 

  • 25.
    Hasson, Henna
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Gröndal, Hedvig
    Karolinska Institutet, Stockholm, Sweden.
    Hedberg Rundgren, Åsa
    Stockholm Gerontology Research Center, Stiftelsen Stockholms läns Äldrecentrum, Stockholm, Sweden.
    Avby, Gunilla
    FoU Nordväst, Research and Development Center for social services in northwestern Stockholm County, Sollentuna, Sweden.
    Ulvhagen, Håkan
    Karolinska Institutet, Stockholm, Sweden.
    von Thiele Schwarz, Ulrica
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Karolinska Institutet, Stockholm, Sweden.
    How can evidence-based interventions give the best value for users in social services? Balance between adherence and adaptations: a study protocol2020Ingår i: Implementation Science Communications, ISSN 2662-2211, Vol. 1, nr 15Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Using evidence-based interventions (EBIs) is a basic premise of contemporary social services (e.g., child and family social services). However, EBIs seldom fit seamlessly into a specific setting but often need to be adapted. Although some adaptions might be necessary, they can cause interventions to be less effective or even unsafe. The challenge of balancing adherence and adaptations when using EBIs is often referred to as the adherence and adaptation dilemma. Although the current literature identifies professionals’ management of this dilemma as problematic, it offers little practical guidance for professionals. This research aims to investigate how the adherence and adaptation dilemma is handled in social services and to explore how structured decision support can impact the management of the dilemma.

    Methods

    The design is a prospective, longitudinal intervention with a focus on the feasibility and usefulness of the structured decision support. The project is a collaboration between academic researchers, embedded researchers at three research and development units, and social service organizations. A multi-method data collection will be employed. Initially, a scoping review will be performed, and the results will be used in the development of a structured decision support. The decision support will be further developed and tested during a series of workshops with social service professionals. Different forms of data—focus group interviews, questionnaires, and documentation—will be used on several occasions to evaluate the impact of the structured decision support. Qualitative and quantitative analysis will be performed and usefulness for practice prioritized throughout the study.

    Discussion

    The study will contribute with knowledge on how the adherence and adaption dilemma is handled and experienced by social service professionals. Most importantly, the study will generate rich empirical data on how a structured decision support impacts professionals’ management of adherence and adaptions. The goal is to produce more strategic and context-sensitive implementation of EBIs in social service, which will increase value for service users.

  • 26.
    Hasson, Henna
    et al.
    Karolinska Inst, Dept Learning Informat Management & Eth, Med Management Ctr, Procome Res Grp, SE-17177 Stockholm, Sweden.;Stockholm Cty Council, Ctr Epidemiol & Community Med CES, Unit Implementat & Evaluat, SE-17129 Stockholm, Sweden..
    Nilsen, Per
    Linkoping Univ, Div Community Med, Dept Med & Hlth Sci, Linkoping, Sweden..
    Augustsson, Hanna
    Karolinska Inst, Dept Learning Informat Management & Eth, Med Management Ctr, Procome Res Grp, SE-17177 Stockholm, Sweden.;Stockholm Cty Council, Ctr Epidemiol & Community Med CES, Unit Implementat & Evaluat, SE-17129 Stockholm, Sweden..
    von Thiele Schwarz, Ulrica
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Karolinska Inst, Stockholm.
    Empirical and conceptual investigation of de-implementation of low-value care from professional and health care system perspectives: a study protocol2018Ingår i: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 13, artikel-id 67Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: A considerable proportion of interventions provided to patients lacks evidence of their effectiveness This implies that patients may receive ineffective, unnecessary, or even harmful care Thus, in addition to implementing evidence based practices, there is also a need to abandon interventions that are not based on best evidence, i e, low value care However, research on de implementation is limited, and there is a lack of knowledge about how effective de implementation processes should be earned out The aim of this project is to explore the phenomenon of the de implementation of low value health care practices from the perspective of professionals and the health care system. Methods: Theories of habits and developmental learning in combination with theories of organizational alignment will be used The project's work will be conducted in five steps Step 1 is a scoping review of the literature, and Step 2 has an explorative design involving interviews with health care stakeholders Step 3 has a prospective design in which workplaces and professionals are shadowed during an ongoing de implementation In Step 4, a conceptual framework for de implementation will be developed based on the previous steps In Step 5, strategies for de implementation are identified using a co design approach. Discussion: This project contributes new knowledge to implementation science consisting of empirical data, a conceptual framework, and strategy suggestions on de implementation of low value care The professionals' perspectives will be highlighted, including insights into how they make decisions, handle de implementation in daily practice, and what consequences it has on their work Furthermore, the health care system perspective will be considered and new knowledge on how de implementation can be understood across health care system levels will be obtained The theories of habits and developmental learning can also offer insights into how context triggers and reinforces certain behaviors and how factors at the individual and the organizational levels interact The project employs a solution oriented perspective by developing a framework for de implementation of low value practices and suggesting practical strategies to improve de implementation processes at all levels of the health care system The framework and the strategies can thereafter be evaluated for their validity and impact in future studies.

  • 27.
    Hasson, Henna
    et al.
    Karolinska Inst, Dept Learning Informat Management & Eth, Med Management Ctr, Stockholm, Sweden.;Ctr Epidemiol & Community Med, Unit Implementat & Evaluat, Stockholm, Sweden..
    von Thiele Schwarz, Ulrica
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Karolinska Inst, Dept Learning Informat Management & Eth, Med Management Ctr, Stockholm, Sweden..
    Tafvelin, Susanne
    Karolinska Inst, Dept Learning Informat Management & Eth, Med Management Ctr, Stockholm, Sweden.;Umea Univ, Umea, Sweden..
    Shared or different realities Self-other agreement on constructive and passive leadership and employee outcomes2020Ingår i: Leadership & Organization Development Journal, ISSN 0143-7739, E-ISSN 1472-5347, Vol. 41, nr 1, s. 37-51Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose The purpose of this paper is to explore the consequences of self-other agreement (SOA) between leaders and subordinates on constructive and passive leadership behaviors for employee well-being, performance and perception of learning climate. Design/methodology/approach Questionnaire ratings of 76 leaders and 211 subordinates in a forest industrial company on full-range leadership and subordinate ratings of well-being, work performance and learning climate have been used in this paper. The data were analyzed using polynomial regression with response surface analysis. Findings SOA on constructive leadership (transformational leadership and contingent reward) was related to subordinates' perception of a positive learning climate. SOA on passive leadership (management-by-exception passive) reduced subordinates' performance, while disagreement reduced their well-being. Originality/value The study demonstrates how SOA on leaders' constructive and passive leadership behaviors impacts employees' well-being, performance and work climate.

  • 28.
    Hvitfeldt, H. Forsberg
    et al.
    Karolinska Inst, S-10401 Stockholm, Sweden..
    Athlin, A. Muntlin
    Uppsala Univ, Uppsala, Sweden.;Univ Adelaide, Adelaide, SA 5005, Australia..
    von Thiele Schwarz, Ulrica
    Karolinska Inst, S-10401 Stockholm, Sweden..
    Multitasking in the emergency department: does it affect the registered nurses' perceptions of their everyday practice?2014Ingår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 22, nr 4, s. 258-258Artikel i tidskrift (Övrigt vetenskapligt)
  • 29.
    Kakeeto, M.
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Lundmark, R.
    Karolinska Institutet, Stockholm, Sweden.
    Hasson, H.
    Karolinska Institutet, Stockholm, Sweden.
    von Thiele Schwarz, Ulrica
    Karolinska Institutet, Stockholm, Sweden.
    Meeting patient needs trumps adherence. A cross-sectional study of adherence and adaptations when national guidelines are used in practice2017Ingår i: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 23, nr 4, s. 830-838Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Rationale, aims and objectives: In the evidence-to-practice pathway, guidelines are developed to provide a practical summary of evidence and stimulate change. However, when guidelines are used in practice, adherence to the recommendations in guidelines is limited, and adaptations are common. Thus, we need more detailed knowledge about adherence and adaptations when guidelines are used in practice to understand the end of the evidence-to-practice pathway. Subsequently, the aim is to examine adherence to and adaptations of recommendations in the Swedish National Guidelines for Methods of Preventing Disease. Material and methods: A questionnaire was sent to healthcare professionals and managers in Stockholm between January and March 2014. Adherence to the recommendations was compared between practice settings, and the frequency of different adaptations and reasons for adaptations was analysed. Results: Partial adherence to the guidelines was found. The adherence was significantly greater within primary care than at the hospitals (P <.001). Modifications formed the most common category of adaptations (55%) and included mainly prioritization of specific patient groups and increased patient customization. The most common reason for adaptations (25%) was to meet the patients' specific needs and capabilities. Conclusions: This study provides insight into adherence and adaptation when guidelines are used in practice. Work with lifestyle habits was partially done in accordance with the guidelines. Lack of time and lack of resources were not the most common reasons for adaptations. Rather, the findings suggest that when patient needs and capabilities contrast with guideline recommendations, patient needs trump adherence to guidelines. 

  • 30.
    Karanika-Murray, M.
    et al.
    Nottingham Trent University, United Kingdom.
    Hasson, H.
    Karolinska Institutet, Stockholm, Sweden.
    von Thiele Schwarz, Ulrica
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Richter, A.
    Karolinska Institutet, Stockholm, Sweden.
    Improving employee wellbeing through leadership development2017Ingår i: The Routledge Companion to Wellbeing at Work, Taylor and Francis Inc. , 2017, s. 332-344Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 31.
    Korlen, Sara
    et al.
    Karolinska Inst, LIME, Med Management Ctr, Stockholm, Sweden..
    Richter, Anne
    Karolinska Inst, LIME, Med Management Ctr,Stockholm, Sweden..
    Amer-Wahlin, Isis
    Karolinska Inst, LIME, Med Management Ctr, Stockholm, Sweden..
    Lindgren, Peter
    Karolinska Inst, LIME, Med Management Ctr, S-17177 Stockholm, Sweden.;Swedish Inst Hlth Econ, Box 2017, S-22002 Lund, Sweden..
    von Thiele Schwarz, Ulrica
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Karolinska Inst, LIME, Med Management Ctr, S-17177 Stockholm, Sweden..
    The development and validation of a scale to explore staff experience of governance of economic efficiency and quality (GOV-EQ) of health care2018Ingår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 18, artikel-id 963Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BackgroundIn publicly funded health care systems, governance models are developed to push public service providers to use tax payers' money more efficiently and maintain a high quality of service. Although this implies change in staff behaviors, evaluation studies commonly focus on organizational outputs. Unintended consequences for staff have been observed in case studies, but theoretical and methodological development is necessary to enable studies of staff experience in larger populations across various settings. The aim of the study is to develop a self-assessment scale of staff experience of the governance of economic efficiency and quality of health care and to assess its psychometric properties.MethodsFactors relevant to staff members' experience of economic efficiency and quality requirements of health care were identified in the literature and through interviews with practitioners, and then compared to a theoretical model of behavior change. Relevant experiences were developed into sub-factors and items. The scale was tested in collaboration with the Department of Rehabilitation Medicine at a university hospital. 93 staff members participated. The scale's psychometric properties were assessed using exploratory factor analysis, analysis of internal consistency and criterion-related validity.ResultsThe analysis revealed an eight factor structure (including sub-factors knowledge and awareness, opportunity to influence, motivation, impact on professional autonomy and organizational alignment), and items showed strong factor loadings and high internal consistency within sub-factors. Sub-factors were interrelated and contributed to the prediction of impact on clinical behavior (criterion).ConclusionsThe scale clearly distinguishes between various experiences regarding economic efficiency and quality requirements among health care staff, and shows satisfactory psychometric quality. The scale has broad applications for research and practice, as it serves as a tool for capturing staff members' perspectives when evaluating and improving health care governance. The scale could also be useful for understanding the underlying processes of changes in provider performance and for adapting management strategies to engage staff in driving change that contributes to increased economic efficiency and quality, for the benefit of health care systems, patients and staff.

  • 32.
    Korlén, S.
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Amer-Wåhlin, I.
    Karolinska Institutet, Stockholm, Sweden.
    Lindgren, P.
    Karolinska Institutet, Stockholm, Sweden.
    von Thiele Schwarz, Ulrica
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Exploring staff experience of economic efficiency requirements in health care: A mixed method study2019Ingår i: International Journal of Health Planning and Management, ISSN 0749-6753, E-ISSN 1099-1751, Vol. 34, nr 4, s. 1439-1455Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Economic resources are limited in health care, and governance strategies are used to push provider organizations to use resources efficiently. Although studies show that hybrid managers are successful in reconciling economic efficiency requirements with professional values to meet patient needs, surprisingly few studies focus on staff. The aim of this study is to explore staff members' experience of economic efficiency requirements. Methods: A mixed method design was applied, targeting multi-professional staff in the Department of Rehabilitation Medicine in a Swedish university hospital. Survey data was collected (n = 93), followed by focus-group interviews to support the understanding of the quantitative findings. Findings: The findings show that health care staff is knowledgeable and intrinsically motivated to consider efficiency requirements, albeit it should not dominate clinical decisions. However, staff experiences little influence over resource allocation and identifies limitations in the system's abilities to meet patient needs. Staff experience incorporates a local unit and a system perspective. Conclusion: Staff members are aware of economic efficiency requirements and will behave accordingly if patients are not at risk. However, their engagement seems to rely on how economic efficiency requirements are handled at multiple system levels and their trust in the system to fairly support patient needs. 

  • 33.
    Korlén, S.
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Amer-Wåhlin, I.
    Karolinska Institutet, Stockholm, Sweden.
    Lindgren, P.
    Karolinska Institutet, Stockholm, Sweden.
    von Thiele Schwarz, Ulrica
    Karolinska Institutet, Stockholm, Sweden.
    Professionals’ perspectives on a market-inspired policy reform: A guiding light to the blind spots of measurement2017Ingår i: Health Services Management Research, ISSN 0951-4848, E-ISSN 1758-1044, Vol. 30, nr 3, s. 148-155Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Implementation of market-inspired competition and incentive models in health care is increasing worldwide, assumed to drive efficiency. However, the evidence for effects is mixed and unintended consequences have been reported. There is a need to better understand the practical consequences of such reforms. The aim of the present case study is to explore what consequences of a Swedish market-inspired patient choice reform professionals identify as relevant, and why. The study was designed as an explorative qualitative study in specialized orthopedics. Nineteen interviews were conducted with health care professionals at different providers. Data were analyzed using a hypo-deductive thematic approach. Consequences for the organization of care, patients, work environment, education and research were included in the professionals’ analyses, covering both the perspective of their own organization and that of the health care system as a whole. In sum, the professionals provided multiple-level analyses that extended beyond the responsibilities of their own organization. Concluding, professionals are a valuable source of knowledge when evaluating policy reforms. Their analyses can contribute by covering a broad system perspective, serving as a guiding light to areas beyond the most obvious evaluation measures that should be included in more formal evaluations. 

  • 34.
    Korlén, S.
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Essén, A.
    Karolinska Institutet, Stockholm, Sweden.
    Amer-Wåhlin, I.
    Karolinska Institutet, Stockholm, Sweden.
    Lindgren, P.
    Institutet för hälso-och sjukvårdsekonomi (IHE), Stockholm, Sweden.
    von Thiele Schwarz, Ulrica
    Karolinska Institute, Stockholm, Sweden.
    Leaders as intermediates between economic incentive models and professional motivation2018Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115, nr 22-23Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The application of economic incentives to providers in health care governance is debated. Advocates argue that it drives efficiency and improvement, opponents claim that it leads to unintended consequences for patients and professionals. Research shows that incentives can increase well-defined activities and targets, but there is a lack of substantial evidence that applications in health care lead to desired outcomes. The motivational literature acknowledges internal sources of motivation as important determinants of behavior, and the literature about professions suggests that professional values of serving patient needs is a key motivator. The management literature identifies the important role of leaders in aligning external demands and rewards to staff preferences, using their own management and leadership skills. Findings in health services research confirm the vital role of leaders for successful implementation and improvement work. In sum, internal motivators and the role of leaders are important to acknowledge also when understanding how economic governance models are put into practice. Our recently published qualitative case study provides empirical examples of how clinical leaders function as intermediaries between a local care choice model, including financial incentives, and the motivation of staff. The strategies deployed by the leaders aimed to align the economic logics of the model to the professional focus on increasing patient value. The main conclusion from these empirical examples, as well as previous research, is that health care managers play a key role in aligning economic incentive models with professional values and in translating such models in to feasible tasks related to the provision of high quality care. 

  • 35.
    Korlén, S.
    et al.
    Karolinska Institute, Stockholm, Sweden.
    Essén, A.
    Stockholm School of Economics, Stockholm, Sweden.
    Lindgren, P.
    Karolinska Institute, Stockholm, Sweden.
    Amer-Wahlin, I.
    Karolinska Institute, Stockholm, Sweden.
    von Thiele Schwarz, Ulrica
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Karolinska Institute, Stockholm, Sweden.
    Managerial strategies to make incentives meaningful and motivating2017Ingår i: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 31, nr 2, s. 126-141Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: Policy makers are applying market-inspired competition and financial incentives to drive efficiency in healthcare. However, a lack of knowledge exists about the process whereby incentives are filtered through organizations to influence staff motivation, and the key role of managers is often overlooked. The purpose of this paper is to explore the strategies managers use as intermediaries between financial incentives and the individual motivation of staff. The authors use empirical data from a local case in Swedish specialized care. Design/methodology/approach: The authors conducted an exploratory qualitative case study of a patient-choice reform, including financial incentives, in specialized orthopedics in Sweden. In total, 17 interviews were conducted with professionals in managerial positions, representing six healthcare providers. A hypo-deductive, thematic approach was used to analyze the data. Findings: The results show that managers applied alignment strategies to make the incentive model motivating for staff. The managers’ strategies are characterized by attempts to align external rewards with professional values based on their contextual and practical knowledge. Managers occasionally overruled the financial logic of the model to safeguard patient needs and expressed an interest in having a closer dialogue with policy makers about improvements. Originality/value: Externally imposed incentives do not automatically motivate healthcare staff. Managers in healthcare play key roles as intermediaries by aligning external rewards with professional values. Managers’ multiple perspectives on healthcare practices and professional culture can also be utilized to improve policy and as a source of knowledge in partnership with policy makers. 

  • 36.
    Lindfors, P.
    et al.
    Stockholm University, Sweden.
    von Thiele Schwarz, Ulrica
    Stockholm University, Sweden.
    Lundberg, U.
    Stockholm University, Sweden.
    Work characteristics and upper extremity disorders in female dental health workers2006Ingår i: Journal of Occupational Health, ISSN 1341-9145, E-ISSN 1348-9585, Vol. 48, nr 3, s. 192-197Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Many dental health workers suffer from musculoskeletal disorders in the upper extremities. In addition to ergonomic factors, psychosocial work characteristics have been linked to musculoskeletal disorders. The present cross-sectional study aimed at investigating how musculoskeletal disorders in the upper extremities (UED) and occupational position are related to work characteristics and general health problems in female dental health workers. Questionnaire data from dentists, dental hygienists and dental nurses ( N=945) showed that 81% reported UED. Multivariate analysis of variance showed that dentists reported the highest levels of physical load and fatigue whereas dental nurses reported the lowest levels of influence at work. Irrespective of position, those with UED considered their physical and psychosocial work environment and their own health to be significantly poorer than did those without UED. A hierarchical multiple regression showed that the physical load of dentistry was most strongly related to UED. Despite improvements to the ergonomics and physical work environment of dentistry, it is concluded that female dental health workers are still at high risk of developing UED.

  • 37.
    Lo Re, Rossana
    et al.
    KTH Royal Institute of Technology, Sweden.
    von Thiele Schwarz, Ulrica
    Karolinska Institutet, Sweden.
    Palm, Kristina
    KTH Royal Institute of Technology, Sweden.
    Reacting and managing: an exploratory study of how middle managers perceive an offshoring decision and implementation program2015Ingår i: International Journal of Strategic Change Management, ISSN 1740-2859, E-ISSN 1740-2867, Vol. 6, nr 3/4, s. 195-212Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The paper aims to study the implementation of an offshoring to captive centres initiative from an organisational change and middle management perspective. Middle managers' views are explored in relation to six dimensions of organisational change, summarised on the basis of the change management literature. The study was carried out at the IT Department of a multinational bank in a Nordic country. The findings show that practices within all dimensions were perceived as highly relevant, showing that implementation of an offshoring initiative may be approached in the same manner as other forms of organisational change. Generally, the practices were perceived to be less-than-well executed, and middle managers felt the need to take on some of the practices typically referred to top management. In sum, when middle managers need to give sense to and implement decisions they are struggling to make sense of themselves, this hampers the possibility for a successful implementation.

  • 38.
    Lornudd, C.
    et al.
    Karolinska Institute, Stockholm, Sweden.
    Bergman, D.
    Karolinska Institute, Stockholm, Sweden.
    Sandahl, C.
    Karolinska Institute, Stockholm, Sweden.
    von Thiele Schwarz, Ulrica
    Karolinska Institute, Stockholm, Sweden.
    A randomised study of leadership interventions for healthcare managers2016Ingår i: Leadership in Health Services, ISSN 1751-1879, E-ISSN 1751-1887, Vol. 29, nr 4, s. 358-376Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: The purpose of this paper was to assess two different leader development interventions by comparing their effects on leadership behaviour and evaluating their combined impact after two years, from the viewpoints of both the participating managers and external raters. Design/methodology/approach: The study was a longitudinal randomised controlled trial with a cross-over design. Health care managers (n = 177) were first randomised to either of two 10-month interventions and a year later were switched to the other intervention. Leadership behaviour was rated at pre-test and 12 and 24 months by participating managers and their superiors, colleagues and subordinates using a 360-degree instrument. Analysis of variance and multilevel regression analysis was performed. Findings: No difference in effect on leadership behaviour was found between the two interventions. The evaluation of the combined effect of the interventions on leadership behaviour showed inconsistent (i.e. both increased and decreased) ratings by the various rater sources. Practical implications: This study provides some evidence that participation in leadership development programmes can improve managers’ leadership behaviours, but the results also highlight the interpretive challenges connected with using a 360-degree instrument to evaluate such development. Originality/value: The longitudinal randomised controlled design and the large sample comprising both managers and external raters make this study unusually rigorous in the field of leadership development evaluations. 

  • 39.
    Lornudd, C.
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Bergman, D.
    Karolinska Institutet, Stockholm, Sweden.
    Sandahl, C.
    Karolinska Institutet, Stockholm, Sweden.
    von Thiele Schwarz, Ulrica
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Karolinska Institutet, Stockholm, Sweden.
    Healthcare managers’ leadership profiles in relation to perceptions of work stressors and stress2016Ingår i: Leadership in Health Services, ISSN 1751-1879, E-ISSN 1751-1887, Vol. 29, nr 2, s. 185-200Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PurposeThe purpose of this study is to investigate the relationship between leadership profiles and differences in managers’ own levels of work stress symptoms and perceptions of work stressors causing stress. Design/methodology/approachCross-sectional data were used. Healthcare managers (n = 188) rated three dimensions of their leadership behavior and levels of work stressors and stress. Hierarchical cluster analysis was performed to identify leadership profiles based on leadership behaviors. Differences in stress-related outcomes between profiles were assessed using one-way analysis of variance. FindingsFour distinct clusters of leadership profiles were found. They discriminated in perception of work stressors and stress: the profile distinguished by the lowest mean in all behavior dimensions, exhibited a pattern with significantly more negative ratings compared to the other profiles. Practical implicationsThis paper proposes that leadership profile is an individual factor involved in the stress process, including work stressors and stress, which may inform targeted health promoting interventions for healthcare managers. Originality/valueThis is the first study to investigate the relationship between leadership profiles and work stressors and stress in healthcare managers. 

  • 40.
    Lornudd, C.
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Tafvelin, S.
    Umeå University, Sweden.
    von Thiele Schwarz, Ulrica
    Karolinska Institutet, Stockholm, Sweden; Stockholm University, Sweden.
    Bergman, D.
    Karolinska Institutet, Stockholm, Sweden.
    The mediating role of demand and control in the relationship between leadership behaviour and employee distress: A cross-sectional study2015Ingår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 52, nr 2, s. 543-554Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The relationship between leadership and employee distress is well established, however, the processes involved in this relationship remain largely unclear. For a stretched nursing workforce, understanding in what ways leadership may influence employee distress is particularly important. Objectives: To examine possible mediating effects of the work environment factors demand and control in the relationship between leadership behaviour in change, production, and employee orientation and employee distress. Design: Cross-sectional study design. Settings: The study was conducted at a large county council in Sweden providing both institutional and non-institutional care. Participants: A random sample of 1249 employees (primarily nurses, but also a wide range of other healthcare professionals and administrative staff), who had a healthcare manager that was about to enter a leadership development programme (n=171), responded to a web-based questionnaire. The response rate was 62%. Methods: The employees rated their healthcare managers' behaviour in change, production, and employee orientation, as well as their own perceptions of level of demand, control (subdivided into decision authority and skill discretion), and five distress outcomes. Multilevel analysis was performed. Results: The mediators demand, decision authority, and skill discretion were significant predictors of all five distress outcomes for all three leadership orientations. In eight of 15 regressions, the mediators fully explained the relationships between leadership orientations and outcomes. Four of five relationships with distress outcomes were fully mediated for change-oriented leadership, whereas two of five outcomes were fully mediated for production- and employee-oriented leadership. In all three leadership orientations, the relationship between the mediator skill discretion and the distress measure disengagement were particularly strong, with B-coefficients (-.44, p<. .001) twice as high as for any of the other relationships. Conclusions: It seems that the way that employees perceive healthcare managers' change-oriented behaviour, and how that aspect is related to employee distress, is primarily explained by perception of demand and control. Furthermore, regardless of leadership behaviour orientation, how employees perceive their opportunity to use specific job skills plays an important role in the interplay between perception of healthcare managers' behaviour and disengagement. 

  • 41.
    Lornudd, Caroline
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Stenfors, Terese
    Karolinska Institutet, Stockholm, Sweden.
    Hasson, Henna
    Karolinska Institutet, Stockholm, Sweden.
    Frykman, Mandus
    Karolinska Institutet, Stockholm, Sweden.
    Sundberg, Carl Johan
    Karolinska Institutet, Stockholm, Sweden.
    von Thiele Schwarz, Ulrica
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Karolinska Institutet, Stockholm, Sweden.
    A piece of the boardroom pie – An interview study exploring what drives Swedish corporate boards’ engagement in occupational health and safetyIngår i: Journal of Occupational and Environmental Medicine, ISSN 1076-2752, E-ISSN 1536-5948Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: 

    To investigate why boards of directors engage in occupational health and safety (OHS) and what influences their level of engagement.

    Methods: 

    Thirty-four board members and chief executive officers at large companies from the manufacturing, construction, trade, and health/social care sectors were interviewed. An inductive thematic analysis was conducted.

    Results: 

    Five drivers organized along a continuum explain why boards engage: legal compliance, untoward events, external expectations/regulations, business drivers, and moral values. Certain factors influence the level of engagement: board's OHS competence, owner's agenda, and competing needs.

    Conclusions: 

    Boards continuously prioritize among multiple foci. If a board's total engagement is likened to a pie, the size of the OHS slice will depend on the drivers, as well as on the influencing factors. We suggest that even boards with many drivers can down-prioritize OHS under certain conditions.

  • 42.
    Lundmark, R.
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Hasson, H.
    Karolinska Institutet, Stockholm, Sweden.
    von Thiele Schwarz, Ulrica
    Karolinska Institutet, Stockholm, Sweden.
    Hasson, D.
    Stress Clinic, Stockholm, Sweden.
    Tafvelin, S.
    Karolinska Institute, Stockholm, Sweden.
    Leading for change: line managers’ influence on the outcomes of an occupational health intervention2017Ingår i: Work & Stress, ISSN 0267-8373, E-ISSN 1464-5335, Vol. 31, nr 3, s. 276-296Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Line managers may play a central role in the success of occupational health interventions. However, few studies have focussed on the relationship between line managers’ behaviours and the outcomes of occupational health interventions. We examined the influence of both line managers’ attitudes and actions towards an intervention as well as their transformational leadership on the expected outcomes of the intervention (i.e. employee self-rated health and work ability). The intervention consisted of the implementation and use of a web-based system for occupational health management. A sample of 180 employees provided data for the analysis. Self-rated health and work ability were measured at the baseline (Time 1) and follow-up (Time 3), while employee ratings of line managers’ attitudes and actions, and transformational leadership were measured during the intervention process (Time 2). The results revealed that line managers’ attitudes and actions positively predicted changes in both self-rated health and work ability. The influence of transformational leadership was indirect and mediated through line managers’ attitudes and actions towards the intervention. Based on the results, we suggest using process measures that include aspects of both line managers’ attitudes and actions as well as their transformational leadership in future process evaluation. 

  • 43.
    Lundmark, R.
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    von Thiele Schwarz, Ulrica
    Karolinska Institutet, Stockholm, Sweden.
    Hasson, H.
    Karolinska Institutet, Stockholm, Sweden.
    Stenling, A.
    Umeå University, Umeå, Sweden.
    Tafvelin, S.
    Umeå University, Umeå, Sweden.
    Making it fit: Associations of line managers' behaviours with the outcomes of an organizational-level intervention2018Ingår i: Stress and Health, ISSN 1532-3005, E-ISSN 1532-2998, Vol. 34, nr 1, s. 163-174Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Line managers' behaviours are important during implementation of occupational health interventions. Still, little is known about how these behaviours are related to intervention outcomes. This study explored the relationship between line managers' intervention-specific transformational leadership (IsTL), intervention fit (the match between the intervention, persons involved, and the surrounding environment), and change in intrinsic motivation and vigour. Both direct and indirect relationships between IsTL and change in intrinsic motivation and vigour were tested. Ninety employees participating in an organizational-level occupational health intervention provided questionnaire ratings at baseline and after 6 months. The results showed IsTL to be related to intervention fit and intervention fit to be related to intrinsic motivation. Using intervention fit as a mediator, the total effects (direct and indirect combined) of IsTL on change in intrinsic motivation and vigour were significant. In addition, IsTL had a specific indirect effect on intrinsic motivation. This study is the first to use IsTL as a measure line managers' behaviours. It is also the first to empirically evaluate the association between intervention fit and intervention outcomes. By including these measures in evaluations of organizational-level occupational health interventions, we can provide more informative answers as to what can make interventions successful. 

  • 44.
    Lundmark, Robert
    et al.
    Umea Univ, Dept Psychol, Umea, Sweden..
    Nielsen, Karina
    Univ Sheffield, Sheffield, S Yorkshire, England..
    Hasson, Henna
    Karolinska Inst, LIME, Stockholm, Sweden..
    von Thiele Schwarz, Ulrica
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Karolinska Inst, LIME, Stockholm, Sweden..
    Tafvelin, Susanne
    Umea Univ, Dept Psychol, Umea, Sweden..
    No leader is an island: contextual antecedents to line managers' constructive and destructive leadership during an organizational intervention2020Ingår i: International Journal of Workplace Health Management, ISSN 1753-8351, E-ISSN 1753-836X, Vol. 13, nr 2, s. 173-188Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose Line managers can make or break organizational interventions, yet little is known about what makes them turn in either direction. As leadership does not occur in a vacuum, it has been suggested that the organizational context plays an important role. Building on the intervention and leadership literature, we examine if span of control and employee readiness for change are related to line managers' leadership during an organizational intervention. Design/methodology/approach Leadership is studied in terms of intervention-specific constructive, as well as passive and active forms of destructive, leadership behaviors. As a sample, we use employees (N = 172) from 37 groups working at a process industry plant. Multilevel analyses over two time points, with both survey and organizational register data were used to analyze the data. Findings The results revealed that span of control was negatively related to constructive leadership and positively related to passive destructive leadership during the intervention. Employee readiness for change was positively related to constructive leadership, and negatively related to both passive and active destructive leadership. Originality/value The present study is the first to address line managers' making or breaking of organizational interventions by examining the influence of context on both their destructive and constructive leadership.

  • 45.
    MacKinnon, Ralph
    et al.
    Karolinska Institute, Sweden.
    Pukk-Härenstam, Karin
    Karolinska Institute, Sweden.
    von Thiele Schwarz, Ulrica
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Karolinska Institute, Sweden.
    Kennedy, Christopher
    Children’s Mercy Hospital Kansas City, Kansas City, USA..
    Stenfors, Terese
    Karolinska Institute, Sweden.
    Defining and measuring quality in acute paediatric trauma stabilisation: a phenomenographic study2019Ingår i: Advances in Simulation, ISSN 2059-0628, Vol. 4, nr 4Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives

    Trauma is the leading cause of death in children. The lack of an accepted definition of what constitutes a high-quality stabilisation of a traumatically injured child has limited the evaluation of direct interventions in simulation-based education and service-delivery models to improve trauma care. The aim of this study was to create a framework that delineates quality by exploring the perceptions of the multi-disciplinary team providing and improving this initial care.

    Methods

    Interviews were conducted with 36 experienced UK trauma team members and governance administrators (clinical directors to executive board level), from three standard UK trauma units. This study used a phenomenographic approach to explore the relationships and hierarchy between the contrasting perceptions of quality and evaluation of quality in this acute context.

    Results

    The findings show that defining quality is a more complex concept than simple proxy measurements, such as time to CT scanning. They also show that the concept of quality requires the consideration of a spectrum of perspectives that range from the simple to the more sophisticated.

    This study highlights the importance of teamwork, individualised perspectives and the culture of care provision, when describing quality. A novel framework to delineate quality is presented, comprising System, Team, Process, Individual, Data and Culture.

    Conclusions

    This study has created a framework of understanding of acute paediatric trauma care quality and its measurement from the perspectives of team members and administrators. A framework and future tools to capture and disseminate the System, Team, Process, Individual, Data and Culture perspectives of the quality of trauma stabilisations could be a key advance in the care of severely injured children.

  • 46.
    Mazzocato, Pamela
    et al.
    Karolinska Inst, Med Management Ctr, Dept Learning Informat Management & Eth, Stockholm, Sweden..
    Stenfors-Hayes, Terese
    Karolinska Inst, Dept Learning Informat Management & Eth, Evaluat Unit, Stockholm, Sweden..
    von Thiele Schwarz, Ulrica
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Karolinska Inst, Med Management Ctr, Dept Learning Informat Management & Eth, Stockholm, Sweden..
    Hasson, Henna
    Karolinska Inst, Med Management Ctr, Dept Learning Informat Management & Eth, Stockholm, Sweden.;Stockholm Cty Council, Ctr Epidemiol & Community Med, Stockholm, Sweden..
    Nystrom, Monica Elisabeth
    Karolinska Inst, Med Management Ctr, Dept Learning Informat Management & Eth, Stockholm, Sweden.;Umea Univ, Dept Publ Hlth & Clin Med Epidemiol & Global Hlth, Umea, Sweden..
    Kaizen practice in healthcare: a qualitative analysis of hospital employees' suggestions for improvement2016Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, nr 7, artikel-id e012256Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: Kaizen, or continuous improvement, lies at the core of lean. Kaizen is implemented through practices that enable employees to propose ideas for improvement and solve problems. The aim of this study is to describe the types of issues and improvement suggestions that hospital employees feel empowered to address through kaizen practices in order to understand when and how kaizen is used in healthcare. Methods: We analysed 186 structured kaizen documents containing improvement suggestions that were produced by 165 employees at a Swedish hospital. Directed content analysis was used to categorise the suggestions into following categories: type of situation (proactive or reactive) triggering an action; type of process addressed (technical/administrative, support and clinical); complexity level (simple or complex); and type of outcomes aimed for (operational or sociotechnical). Compliance to the kaizen template was calculated. Results: 72% of the improvement suggestions were reactions to a perceived problem. Support, technical and administrative, and primary clinical processes were involved in 47%, 38% and 16% of the suggestions, respectively. The majority of the kaizen documents addressed simple situations and focused on operational outcomes. The degree of compliance to the kaizen template was high for several items concerning the identification of problems and the proposed solutions, and low for items related to the test and implementation of solutions. Conclusions: There is a need to combine kaizen practices with improvement and innovation practices that help staff and managers to address complex issues, such as the improvement of clinical care processes. The limited focus on sociotechnical aspects and the partial compliance to kaizen templates may indicate a limited understanding of the entire kaizen process and of how it relates to the overall organisational goals. This in turn can hamper the sustainability of kaizen practices and results.

  • 47.
    Molnar, Malin Mattson
    et al.
    Stockholm University, Sweden.
    von Thiele Schwarz, Ulrica
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Hellgren, Johnny
    Stockholm University, Sweden.
    Hasson, Henna
    Stockholm County Council, Sweden.
    Tafvelin, Susanne
    Karolinska Institutet, Sweden.
    Leading for safety: A question of leadership focus2019Ingår i: Safety and Health at Work, ISSN 2093-7911, Vol. 10, nr 2, s. 180-187Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    There is considerable evidence that leadership influences workplace safety, but less is known about the relative importance of different leadership styles for safety. In addition, a leadership style characterized by an emphasis and a focus on promoting safety has rarely been investigated alongside other more general leadership styles.

    Methods

    Data was collected through a survey to which 269 employees in a paper mill company responded. A regression analysis was conducted to examine the relative roles of transformational, transactional (management-by-exception active; MBEA), and safety-specific leadership for different safety behavioral outcomes (compliance behavior and safety initiative behaviors) and for minor and major injuries.

    Results

    A safety-specific leadership contributed the most to the enhanced safety of the three different kinds of leadership. Transformational leadership did not contribute to any safety outcome over and above that of a safety-specific leadership, while a transactional leadership (MBEA) was associated with negative safety outcomes (fewer safety initiatives and increased minor injuries).

    Conclusion

    The most important thing for leaders aiming at improving workplace safety is to continuously emphasize safety, both in their communication and by acting as role models. This highlights the importance for leadership training programs aiming to improve safety to actually focus on safety promoting communication and behaviors rather than general leadership. Furthermore, an overly monitoring and controlling leadership style can be detrimental to attempts at achieving improved workplace safety.

  • 48.
    Mosson, R.
    et al.
    Karolinska Institutet.
    Augustsson, H.
    Karolinska Institutet.
    Bäck, A.
    Karolinska Institutet.
    Åhström, M.
    Stockholm County Council.
    von Thiele Schwarz, Ulrica
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Karolinska Institutet.
    Richter, Johan
    Mälardalens högskola, Akademin för utbildning, kultur och kommunikation, Utbildningsvetenskap och Matematik. Karolinska Institutet.
    Gunnarsson, M.
    Stockholm County Council.
    Hasson, H.
    Stockholm County Council.
    Building implementation capacity (BIC): A longitudinal mixed methods evaluation of a team intervention2019Ingår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 19, nr 1, artikel-id 287Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Managers and professionals in health and social care are required to implement evidence-based methods. Despite this, they generally lack training in implementation. In clinical settings, implementation is often a team effort, so it calls for team training. The aim of this study was to evaluate the effects of the Building Implementation Capacity (BIC) intervention that targets teams of professionals, including their managers. Methods: A non-randomized design was used, with two intervention cases (each consisting of two groups). The longitudinal, mixed-methods evaluation included pre-post and workshop-evaluation questionnaires, and interviews following Kirkpatrick's four-level evaluation framework. The intervention was delivered in five workshops, using a systematic implementation method with exercises and practical working materials. To improve transfer of training, the teams' managers were included. Practical experiences were combined with theoretical knowledge, social interactions, reflections, and peer support. Results: Overall, the participants were satisfied with the intervention (first level), and all groups increased their self-rated implementation knowledge (second level). The qualitative results indicated that most participants applied what they had learned by enacting new implementation behaviors (third level). However, they only partially applied the implementation method, as they did not use the planned systematic approach. A few changes in organizational results occurred (fourth level). Conclusions: The intervention had positive effects with regard to the first two levels of the evaluation model; that is, the participants were satisfied with the intervention and improved their knowledge and skills. Some positive changes also occurred on the third level (behaviors) and fourth level (organizational results), but these were not as clear as the results for the first two levels. This highlights the fact that further optimization is needed to improve transfer of training when building teams' implementation capacity. In addition to considering the design of such interventions, the organizational context and the participants' characteristics may also need to be considered to maximize the chances that the learned skills will be successfully transferred to behaviors.

  • 49.
    Mosson, R.
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Hasson, H.
    Stockholm County Council, Sweden.
    Wallin, L.
    Dalarna University, Falun, Sweden.
    von Thiele Schwarz, Ulrica
    Karolinska Institutet, Stockholm, Sweden.
    Exploring the role of line managers in implementing evidence-based practice in social services and older people care2017Ingår i: British Journal of Social Work, ISSN 0045-3102, E-ISSN 1468-263X, Vol. 47, nr 2, s. 542-560Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This qualitative study explored the vital role of line managers, namely the managerial level directly above employees, in effectively implementing evidence-based practice (EBP) from their own perspectives. Interviews were carried out with twenty-eight line managers within social services and older people care in seven Swedish municipalities. Thematic analysis was performed. Findings revealed that managers in social care perceived their role as important in implementing EBP. However, notable differences were observed between the two settings, where social services managers had more knowledge and held more positive attitudes towards working according to EBP, and described a more active role in the implementation process than managers in older people care. Overall, the implementation of EBP was performed ad hoc rather than systematically, and with little consideration to analysis of needs according to the local context and limited focus on follow-up and sustainability. This study highlighted that line managers in social services and older people care have different prerequisites for implementing EBP, and are greatly dependent on organisational strategies and context. Gaining knowledge of line managers' perceptions is essential for making informed decisions regarding the support required to achieve EBP in social care, and thus for providing the best possible care for clients. 

  • 50.
    Mosson, R.
    et al.
    Department of Learning Informatics, Management and Ethics, Procome Research Group, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    von Thiele Schwarz, Ulrica
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Department of Learning Informatics, Management and Ethics, Procome Research Group, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Hasson, H.
    Unit for Implementation and Evaluation, Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden.
    Lundmark, R.
    Department of Learning Informatics, Management and Ethics, Procome Research Group, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Richter, A.
    Department of Learning Informatics, Management and Ethics, Procome Research Group, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    How do iLead?: Validation of a scale measuring active and passive implementation leadership in Swedish healthcare2018Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, nr 6, artikel-id e021992Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives This study aims to describe the creation of a scale-the iLead scale-through adaptations of existing domain-specific scales that measure active and passive implementation leadership, and to describe the psychometric properties of this scale. Methods Data collected from a leadership intervention were used in this validation study. Respondents were 336 healthcare professionals (90% female and 10% male; mean age 47 years) whose first-line and second-line managers participated in the intervention. The data were collected in the Stockholm regional healthcare organisation that offer primary, psychiatric, rehabilitation and acute hospital care, among other areas. The items for measuring implementation leadership were based on existent research and the full-range leadership model. Confirmatory factor analysis was performed to evaluate the dimensionality of the scale, followed by tests for reliability and convergent, discriminant and criterion-related validity using correlations and multilevel regression analyses. Results The final scale consists of 16 items clustered into four subscales representing active implementation leadership, and one scale signifying passive implementation leadership. Findings showed that the hypothesised model had an acceptable model fit (Ï ‡ 2 (99) =382.864∗∗, Comparative Fit Index=0.935, Tucker-Lewis Index=0.911, root mean square error of approximation=0.059). The internal consistency and convergent, discriminant and criterion-related validity were all satisfactory. Conclusions The iLead scale is a valid measure of implementation leadership and is a tool for understanding how active and passive leader behaviours influence an implementation process. This brief scale may be particularly valuable to apply in training focusing on facilitating implementation, and in evaluating leader training. Moreover, the scale can be useful in evaluating various leader behaviours associated with implementation success or failure.

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