Gudbjörg Erlingsdottir

Variations in professions' adaption of quality reforms: The cases of doctors and auditors in Sweden

This article investigates variations in two professions’ adaption of quality reforms. The adaption of reforms is viewed as a part of the professions’ legitimacy and identity processes. Literature in the area suggests that the adaption of reforms is influenced by the profession’s knowledge base, professional norms, organizational belonging and organizational field. The two cases here on how doctors and auditors adapt to quality reforms show that the influences of these factors are, however, moulded by the professions’ strategies and the salience of the different aforementioned factors. A general conclusion is that compatibility between the bases of knowledge and the professional norms are vital for the adaption of reforms and that organizational fields are important for setting the agenda. Organizational belongings, on the other hand, seem of less importance for adaption of quality reforms.

Open Notes in Swedish Psychiatric Care (Part 1): Survey Among Psychiatric Care Professionals

Background When the Swedish version of Open Notes, an electronic health record (EHR) service that allows patients online access, was introduced in hospitals, primary care, and specialized care in 2012, psychiatric care was exempt. This was because psychiatric notes were considered too sensitive for patient access. However, as the first region in Sweden, Region Skåne added adult psychiatry to its Open Notes service in 2015. This made it possible to carry out a unique baseline study to investigate how different health care professionals (HCPs) in adult psychiatric care in the region expect Open Notes to impact their patients and their practice. This is the first of two papers about the implementation of Open Notes in adult psychiatric care in Region Skåne. Objective The objective of this study was to describe, compare, and discuss how different HCPs in adult psychiatric care in Region Skåne expect Open Notes to impact their patients and their own practice. Methods A full population Web-based questionnaire was distributed to psychiatric care professionals in Region Skåne in late 2015. The response rate was 28.86% (871/3017). Analyses show that the respondents were representative of the staff as a whole. A statistical analysis examined the relationships between different professionals and attitudes to the Open Notes service. Results The results show that the psychiatric HCPs are generally of the opinion that the service would affect their own practice and their patients negatively. The most striking result was that more than 60% of both doctors (80/132, 60.6%) and psychologists (55/90, 61%) were concerned that they would be less candid in their documentation in the future. Conclusions Open Notes can increase the transparency between patients and psychiatric HCPs because patients are able to access their EHRs online without delay and thus, can read notes that have not yet been approved by the responsible HCP. This may be one explanation as to why HCPs are concerned that the service will affect both their own work and their patients.

Driving for successful change processes in healthcare by putting staff at the wheel

Purpose The purpose of this paper is to describe five salient factors that emerge in two successful change processes in healthcare. Organizational changes in healthcare are often characterized by problems and solutions that have been formulated by higher levels of management. This top-down management approach has not been well received by the professional community. As a result, improvement processes are frequently abandoned, resulting in disrupted and dysfunctional organizations. This paper presents two successful change processes where managerial leadership was used to coach the change processes by distributing mandates and resources. After being managerially initiated, both processes were driven by local agency, decisions, planning and engagement. Design/methodology/approach The data in the paper derive from two qualitative case studies. Data were collected through in-depth interviews, observations and document studies. The cases are presented as process descriptions covering the different phases of the change processes. The focus in the studies is on the roles and interactions of the actors involved, the type of leadership and the distribution of agency. Findings Five factors emerged as paramount to the successful change processes in the two cases: local ownership of problems; a coached process where management initiates the change process and the problem recognition, and then lets the staff define the problems, formulate solutions and drive necessary changes; distributed leadership directed at enabling and supporting the staffs intentions and long-term self-leadership; mutually formulated norms and values that serve as a unifying force for the staff; and generous time allocation and planning, which allows the process to take time, and creates room for reevaluation. The authors also noted that in both cases, reorganization into multi-professional teams lent stability and endurance to the completed changes. Originality/value The research shows how management can initiate and support successful change processes that are staff driven and characterized by local agency, decisions, planning and engagement. Empirical descriptions of successful change processes are rare, which is why the description of such processes in this research increases the value of the paper.

Challenges from Integrating Usability Activities in Scrum: Why Is Scrum so Fashionable?

Scrum is currently a widely used process in most areas of software development. Conversely, usability activities as prescribed in the area of HCI are not widely used in the software industry, especially not in agile software development projects. Through an analysis of interview and survey data from five studies we scrutinize the reasons for choosing Scrum, consequences of using Scrum, and study the challenges of integrating usability activities in Scrum projects are scrutinized. Our results show that the IT professionals appreciate the inherent values in Scrum, which are speed and communication internal to the Scrum team. Also, working in teams and focusing on a small number of tasks at a time is valued. The main challenges are that including specialists in the teams is hard and Scrum does not always match with external requirements for the organizations. Usability activities in Scrum are found to be informal and implicit, even sometimes hidden behind more fashionable concepts such as security and accessibility to increase priority. In addition, usability activities are often seen as not fitting in the pace of the project. Two of the underlying questions in the paper are: Why is Scrum so fashionable? How can usability activities be better integrated in agile projects? Answers to these questions are discussed in the chapter.

What do doctors mean when they talk about teamwork? possible implications for interprofessional care

ABSTRACT The concept of teamwork has been associated with improved patient safety, more effective care and a better work environment. However, the academic literature on teamwork is pluralistic, and there are reports on discrepancies between theory and practice. Furthermore, healthcare professionals’ direct conceptualizations of teamwork are sometimes missing in the research. In this study, we examine doctors’ conceptualizations of teamwork. We also investigate what doctors think is important in order to achieve good teamwork, and how the empirical findings relate to theory. Finally, we discuss the methodological implications for future studies. The research design was explorative. The main data consisted of semi-structured interviews with twenty clinically active doctors, analyzed with conventional content analysis. Additional data sources included field observations and interviews with management staff. There was large variation in the doctors’ conceptualizations of teamwork. The only characteristic they shared in common was that team members should have specific roles. This could have consequences for practice, because the rationale behind different behaviors depends on how teamwork is conceptualized. Several of the teamwork-enabling factors identified concerned non-technical skills. Future studies should put more emphasis on the practitioners’ perspective in the research design, to create a more grounded foundation for both research and practice.

Conceptual Design of E-health Services by, and for Support of, Home Care Staff

Together with staff from home care from four municipalities we investigated how e-health services can improve the work environment. In a series of four workshops we coached the participants in (1) describing their work process and pinpointing the problematic situations in the process, (2) formulating their wishes for an ideal work process, (3) conceptualizing how e-health solutions can be used to obtain the ideal work process and describing scenarios (4) illustrating the scenarios and the design process on storyboards. The storyboards describe, amongst other, how support through e-health systems may be used to: gain access to adequate information; get in touch with other professionals as doctors or other colleagues; prevent medication errors, and to transfer images or physiological data to an expert who can directly provide personal support.

Evaluating Innovations for the Physical Environment in Home Care – A Workplace for One, A Home for the Other

To a higher degree, older adults will live to old age in their own homes with the assistance of home care services. One effect of this is an increased number of people working in the home environment. This paper presents the results from a research project that studied the physical environment in Swedish home care. Innovations to support the home care situation were developed, with the aim of contributing to patient safety and improving working conditions, without diminishing the homelike atmosphere. These innovations were evaluated by both the care recipients and home care staff. The number of generated ideas shows the potential for improving the way in which home care is performed. One example is piece of storage furniture that addresses many of the identified problem areas. This was well received by the staff and residents. One challenge with the type of products presented is that they are neither direct work tools nor aids for the elderly, which means that in today’s organization in Sweden, there is no system for financing them.

The usage of learning journals in a Technology Management Education

Place Technology Management is a unique program at Lund University, where a selected number (40) of students from the Faculty of Economics and from the Faculty of Engineering are taught together during their last 2 years of study. Their degree will be a Masters degree. Their views on problems and challenges in todays industry often complement each other. In addition it is important to complement their academic knowledge with insights about themselves and their own behavior. The introduction of so-called Learning Journals has proved to be a successful step in this direction. The learning journals are introduced in the course Project Leadership. Throughout the whole course (2 semesters) the students are writing learning journals and supervisors are commenting monthly. The learning journals have the purpose of 1) enabling personal reflection on the own process, 2) enabling reflection on the own position and part in the group, and 3) through the longitudinal effect of the course; it provides an opportunity to compare journals over time to become aware of and able to analyze the own learning process. In a newly performed Placement report, students that have graduated from the Technology Management programme the last 10 years, rate their education 4.37 out of 5. Some students even consider the Learning Journals among the most valuable parts of the whole programme in retrospect.