Profits in everyday life : local development in a corporate form

Medias rapporter om nedskärningar i välfärd och service, inte minst på Sveriges landsbygd, kommer allt tätare. Allt fler bygder väljer nu att ta aktiv del i att kompensera för dessa och gjuta nytt liv i bygden, bland annat genom att starta lokala utvecklingsbolag i en ny form av aktiebolag med särskild vinstutdelningsbegränsning (svb). I denna kandidatuppsats inom ämnet landsbygdsutveckling undersöker jag utvecklingsbolagens lokala roll och hur de kan förstås i förhållande till det senmoderna samhället. Frågan har undersökts genom en kvalitativ intervjustudie i sörmländska Stavsjö där engagerade bildat bolaget ”Kiladalens utveckling” och genom mitt deltagande i en nationell träff för så kallade svb-bolag. Begrepp som governmentality, system och livsvärld och kapital har varit centrala för analysen. Undersökningen visar att bygder som innehar specifika former av kapital där kunskap, kontakter och trovärdighet ingår i kombination med stort engagemang, kan nyttja det ökade individuella ansvaret som kommit av att staten i allt högre grad styr på avstånd. Denna utveckling riskerar att bidra till ökade klyftor mellan orter, men detta kan motverkas genom att kunskap sprids till orter som saknar komparativa fördelar genom någon typ av samordning eller nätverk. Initiativen som nu pågår runt om på Sveriges landsbygd tycks grunda sig i en känsla av gemensamt ansvar för den lokala bygden och kan stärka service, social samvaro och kommunikation.Swedish media reports about welfare and service reductions within the Swedish countryside have steadily increased. A growing number of local communities now choose to actively take part in compensating for these reductions and to add new life to the local community. Some approach this by starting local development corporations in a form of limited corporation with limited bonus allocation, shortened SVB (SVB-corporations could be compared to the English community in-terest company or American low profit limited liability company). In this bachelor thesis in the subject of rural development I examine the role of these local development companies and how they can be un-derstood in relation to a late modern society. The examination is based on a qualitative interview study of the local development corporation ”Kiladalens utveckling” in the Swedish village Stavsjö and on my participation in a national meeting hosted by and for SVB-corporations. Concepts such as governmentality, system and lifeworld and capital have been central for my analysis. The examination has shown that local communities that possess certain forms of capital of which knowledge, contacts and credibility are part, in combination with extensive commitment can make use of the increasing individual responsibility that comes with a state which increasingly governs at a distance. This development risks to increase the gap between local communities in terms of development and welfare, but this could be prevented by networks spreading the gained knowledge to communi-ties without comparative advantages. The initiatives that take place throughout the Swedish countryside seems to be based on a sense of common responsibility for the local community and could strengthen service, social relations and communication

Farewell welfare : local manifestations of the welfare society in two rural Swedish towns

In this master's thesis, I investigate the local manifestations of the welfare state through a case study of two Swedish small rural towns. Using local stories and narratives collected through in-depth interviews and observations, I follow the development of the towns from the 30's until today. I examine the development through the aspects of modernity, market driven marginalization, industrialization, administrative rationalization, extended communities and collective remembering through instant media. I use theoretical concepts such as place, identity and Anthony Giddens structuration theory to understand how the welfare society has affected the local acting space of people and the creation of the local places. I conclude that the national project the welfare state had and still have very situated and local effects, which differ much in my two different towns. Factors such as location, locality and the people of the local community impact on how structures coming from the outside are understood and used locally. The structures frame the local acting space, but they also become locally structured. The welfare society has had a large influence on the appearances and functions of today's towns. It has transformed them from small trivial villages to modern service centers, but also stripped away some of their functions through further rationalization and modernization, which locally is perceived as a marginalizing let down. Through protesting against this marginalization, the inhabitants of the town create new acting space and further affect the local place and development. Concluding, the welfare society is a national, structuring phenomenon. However, it is in the local setting that people meet it and understand its influence as either limiting or enabling. It is therefore the conditions of the local place that create the welfare society in which we actually live

Key factors influencing adoption of an innovation in primary health care: a qualitative study based on implementation theory

<p>Abstract</p> <p>Background</p> <p>Bridging the knowledge-to-practice gap in health care is an important issue that has gained interest in recent years. Implementing new methods, guidelines or tools into routine care, however, is a slow and unpredictable process, and the factors that play a role in the change process are not yet fully understood. There is a number of theories concerned with factors predicting successful implementation in various settings, however, this issue is insufficiently studied in primary health care (PHC). The objective of this article was to apply implementation theory to identify key factors influencing the adoption of an innovation being introduced in PHC in Sweden.</p> <p>Methods</p> <p>A qualitative study was carried out with staff at six PHC units in Sweden where a computer-based test for lifestyle intervention had been implemented. Two different implementation strategies, implicit or explicit, were used. Sixteen focus group interviews and two individual interviews were performed. In the analysis a theoretical framework based on studies of implementation in health service organizations, was applied to identify key factors influencing adoption.</p> <p>Results</p> <p>The theoretical framework proved to be relevant for studies in PHC. Adoption was positively influenced by positive expectations at the unit, perceptions of the innovation being compatible with existing routines and perceived advantages. An explicit implementation strategy and positive opinions on change and innovation were also associated with adoption. Organizational changes and staff shortages coinciding with implementation seemed to be obstacles for the adoption process.</p> <p>Conclusion</p> <p>When implementation theory obtained from studies in other areas was applied in PHC it proved to be relevant for this particular setting. Based on our results, factors to be taken into account in the planning of the implementation of a new tool in PHC should include assessment of staff expectations, assessment of the perceived need for the innovation to be implemented, and of its potential compatibility with existing routines. Regarding context, we suggest that implementation concurrent with other major organizational changes should be avoided. The choice of implementation strategy should be given thorough consideration.</p

Experiences of the implementation of a tool for lifestyle intervention in primary health care: a qualitative study among managers and professional groups

<p>Abstract</p> <p>Background</p> <p>In recent years there has been increasing interest in transferring new knowledge into health care practices, a process often referred to as implementation. The various subcultures that exist among health care workers may be an obstacle in this process. The aim of this study was to explore how professional groups and managers experienced the implementation of a new tool for lifestyle intervention in primary health care (PHC). The computer-based tool was introduced with the intention of facilitating the delivery of preventive services.</p> <p>Methods</p> <p>Focus group interviews with staff and individual interviews with managers at six PHC units in the southeast of Sweden were performed 9 months after the introduction of the new working tool. Staff interviews were conducted in groups according to profession, and were analysed using manifest content analysis. Experiences and opinions from the different staff groups and from managers were analysed.</p> <p>Results</p> <p>Implementation preconditions, opinions about the lifestyle test, and opinions about usage were the main areas identified. In each of the groups, managers and professionals, factors related to the existing subcultures seemed to influence their experiences of the implementation. Managers were visionary, GPs were reluctant, nurses were open, and nurse assistants were indifferent.</p> <p>Conclusion</p> <p>This study indicates that the existing subcultures in PHC influence how the implementation of an innovation is perceived by managers and the different professionals. In PHC, an organization with several subcultures and an established hierarchical structure, an implementation strategy aimed at all groups did not seem to result in a successful uptake of the new method.</p

Asthma and COPD in primary health care, quality according to national guidelines: a cross-sectional and a retrospective study

<p>Abstract</p> <p>Background</p> <p>In recent decades international and national guidelines have been formulated to ensure that patients suffering from specific diseases receive evidence-based care. In 2004 the National Swedish Board of Health and Welfare (SoS) published guidelines concerning the management of patients with asthma and COPD. The guidelines identify quality indicators that should be fulfilled. The aim of this study was to survey structure and process indicators, according to the asthma and COPD guidelines, in primary health care, and to identify correlations between structure and process quality results.</p> <p>Methods</p> <p>A cross-sectional study of existing structure by using a questionnaire, and a retrospective study of process quality based on a review of measures documented in asthma and COPD medical records. All 42 primary health care centres in the county council of Östergötland, Sweden, were included.</p> <p>Results</p> <p>All centres showed high quality regarding structure, although there was a large difference in time reserved for Asthma and COPD Nurse Practice (ACNP). The difference in reserved time was reflected in process quality results. The time needed to reach the highest levels of spirometry and current smoking habit documentation was between 1 and 1 1/2 hours per week per 1000 patients registered at the centre. Less time resulted in fewer patients examined with spirometry, and fewer medical records with smoking habits documented. More time did not result in higher levels, but in more frequent contact with each patient. In the COPD group more time resulted in higher levels of pulse oximetry and weight registration.</p> <p>Conclusion</p> <p>To provide asthma and COPD patients with high process quality in primary care according to national Swedish guidelines, at least one hour per week per 1000 patients registered at the primary health care centre should be reserved for ACNP.</p

Implementation strategies to enhance management of heavy alcohol consumption in primary health care: a meta-analysis

Background and AimsScreening and brief interventions (SBI) delivered in primary health care (PHC) are cost-effective in decreasing alcohol consumption; however, they are underused. This study aims to identify implementation strategies that focus on SBI uptake and measure impact on: (1) heavy drinking and (2) delivery of SBI in PHC. MethodsMeta-analysis was conducted of controlled trials of SBI implementation strategies in PHC to reduce heavy drinking. Key outcomes included alcohol consumption, screening, brief interventions and costs in PHC. Predictor measures concerned single versus multiple strategies, type of strategy, duration and physician-only input versus that including mid-level professionals. Standardized mean differences (SMD) were calculated to indicate the impact of implementation strategies on key outcomes. Effect sizes were aggregated using meta-regression models. ResultsThe 29 included studies were of moderate methodological quality. Strategies had no overall impact on patients' reported alcohol consumption [SMD=0.07; 95% confidence interval (CI)= -0.02 to 0.16], despite improving screening (SMD=0.53; 95% CI=0.28-0.78) and brief intervention delivery (SMD=0.64;95% CI=0.27-1.02). Multi-faceted strategies, i.e. professional and/or organizational and/or patient-orientated strategies, seemed to have strongest effects on patients' alcohol consumption (P<0.05, compared with professional-orientated strategies alone). Regarding SBI delivery, combining professional with patient-orientated implementation strategies had the highest impact (P<0.05). Involving other staff besides physicians was beneficial for screening (P<0.05). ConclusionsTo increase delivery of alcohol screening and brief interventions and decrease patients' alcohol consumption, implementation strategies should include a combination of patient-, professional- and organizational-orientated approaches and involve mid-level health professionals as well as physicians

New Developments in Brief Interventions to Treat Problem Drinking in Nonspecialty Health Care Settings

The delivery of brief interventions (BIs) in health care settings to reduce problematic alcohol consumption is a key preventive strategy for public health. However, evidence of effectiveness beyond primary care is inconsistent. Patient populations and intervention components are heterogeneous. Also, evidence for successful implementation strategies is limited. In this article, recent literature is reviewed covering BI effectiveness for patient populations and subgroups, and design and implementation of BIs. Support is evident for short-term effectiveness in hospital settings, but long-term effects may be confounded by changes in control groups. Limited evidence suggests effectiveness with young patients not admitted as a consequence of alcohol, dependent patients, and binge drinkers. Influential BI components include high-quality change plans and provider characteristics. Health professionals endorse BI and feel confident in delivering it, but training and support initiatives continue to show no significant effects on uptake, prompting calls for systematic approaches to implementing BI in health care