Suspended Sentences and Free-Standing Probation Orders in U.S. Guidelines Systems: A Survey and Assessment

Much academic attention has been directed towards management models, but there is limited research into the details of how these models are put to use in organizations. In this paper, we employ a multi-theoretical process perspective on the introduction of Balanced Scorecard in a Swedish healthcare organization. Through the application of actor-network theory, behavior setting theory and distributed cognition, we have identified a set of complementary observations and conclusions. First, we claim that a critical mass of actors is needed to support the change effort. We also emphasize the need for a problematization process in which critical voices are given room to influence the introduction. Further, we stress the importance of aligning the physical environment with organizational goals, and argue that well-designed feedback mechanisms may prevent undesired decoupling of managerial practice.Working paper

Digital inclusion in a disadvantaged Swedish suburb – Trust and participation to form Quality of Government

Digital inclusion is the key for a sustainable and inclusive society. In particular, digital governmental services must be impartial, inclusive and available for everyone eligible for the services. Digital inclusion is a key for trust of government in a more digital society. However, the motives access, use and competences to be digital included varies in line with other forms socio-economic stratification. It is also complicated to reach those who are digital excluded in traditional survey methods. This paper presents a field study on digital inclusion in a disadvantaged Swedish suburb, where we made a structured interview survey to reach groups that are usually hard to survey. The analysis shows that those who find it easy to search on the Internet also experience more inclusion in the Swedish society. In addition, more advanced use as on-line payments and use of eID seems to increase the trust in public authorities. Thereby, digital inclusion can be seen as a factor enhancing even quality of government, that has to be further investigated

Towards a quality management competence framework: exploring needed competencies in quality management

Few empirical studies have focused on what quality management practitioners actually do, with even fewer studies focusing on what it actually takes to do quality management work, i.e. the competencies of quality management. The purpose of this paper is to introduce a competence-based terminology for describing general competencies of quality management work in organisations and to create a competence framework in order to understand what is needed to be a quality management practitioner. This paper is based on an embedded, qualitative multiple-case study design incorporating four Swedish large size organisations where designated quality management practitioners (n = 33) were selected and interviewed. A quality management competence framework incorporating four main quality management competence dimensions is presented: the human, the methods & process, the conceptual and the contextual competence dimensions. Four generic quality management role responsibilities are also posited: centralised & strategic, centralised & operational, local & strategic and local & operational role responsibilities. The competencies and role responsibilities are discussed in relation to the notion of emergent quality management and the emerging need of more integrative and business excellence-oriented quality management

Exploring power shifts as an enabler for a strengthened patient role in quality improvements: A Swedish survey study

Objectives This study examined the relationship between professionals\u27 perceptions of a strengthened role for the patient and of patient involvement in quality improvement (QI) and whether professionals\u27 experiences in improvement science were a moderator on such a relationship. Design From a predominantly close-ended, 44-item questionnaire, 4 questions specifically concerning professionals′ perception on patient involvement in QI were analysed. Setting Three Swedish regions. Participants 155 healthcare professionals who had previously participated in courses in improvement science. Results The covariate patient involvement was significantly related to a perceived strengthened patient role. There was also a significant interaction effect between degree of patient involvement and professionals\u27 experience in the area of improvement science on a strengthened patient role. The result shows that there is a relationship between the perceived level of patient involvement in improvements and professionals\u27 perceptions of a strengthened patient role. In this study, the covariate, perceived patient involvement, was significantly related to experiences of more equal relationships between patients and healthcare professionals. There was also a significant interaction effect between the degree of patient involvement and professionals\u27 experience in the area of improvement science, for a more equal relationship between patients and healthcare professionals. Conclusion Increased patient involvement in QI is a means of strengthening the patient role and supporting a more equal relation between patients and healthcare professionals. Furthermore, empirical evidence shows that the healthcare professionals\u27 experiences in the area of improvement science support a strengthened patient role and a more equal power relationship, but for this to happen, the mindset of professionals is key. Future research is needed to capture and investigate the experiences from patients and relatives about being involved in QI in healthcare, and to study the effects on quality in care processes

Exploring the phase for highest impact on radicality: a cross-sectional study of patient involvement in quality improvement in Swedish healthcare

Objectives Involving patients in quality improvement is often suggested as a critical step for improving healthcare processes. However, this comes with challenges related to resources, tokenism, validity and competence. Therefore, to optimise the use of available resources, there is a need to understand at what stage in the improvement cycle patient involvement is most beneficial. Thus, the purpose of this study was to identify the phase of an improvement cycle in which patient involvement had the highest impact on radicality of improvement.Design An exploratory cross-sectional survey was used.Setting and methods A questionnaire was completed by 155 Swedish healthcare professionals (response rate 34%) who had trained and had experience in patient involvement in quality improvement. Based on their replies, the impact of patient involvement on radicality in various phases of the improvement cycle was modelled using the partial least squares method.Results Patient involvement in quality improvement might help to identify and realise innovative solutions; however, there is variation in the impact of patient involvement on perceived radicality depending on the phase in which patients become involved. The highest impact on radicality was observed in the phases of capture experiences and taking action, while a moderate impact was observed in the evaluate phase. The lowest impact was observed in the identify and prioritise phase.Conclusions Involving patients in improvement projects can enhance the quality of care and help to identify radically new ways of delivering care. This study shows that it is possible to suggest at what point in an improvement cycle patient involvement has the highest impact, which will enable more efficient use of the resources available for patient involvement

How does lean work in emergency care? A case study of a lean-inspired intervention at the Astrid Lindgren Children's hospital, Stockholm, Sweden

<p>Abstract</p> <p>Background</p> <p>There is growing interest in applying lean thinking in healthcare, yet, there is still limited knowledge of how and why lean interventions succeed (or fail). To address this gap, this in-depth case study examines a lean-inspired intervention in a Swedish pediatric Accident and Emergency department.</p> <p>Methods</p> <p>We used a mixed methods explanatory single case study design. Hospital performance data were analyzed using analysis of variance (ANOVA) and statistical process control techniques to assess changes in performance one year before and two years after the intervention. We collected qualitative data through non-participant observations, semi-structured interviews, and internal documents to describe the process and content of the lean intervention. We then analyzed empirical findings using four theoretical lean principles (Spear and Bowen 1999) to understand how and why the intervention worked in its local context as well as to identify its strengths and weaknesses.</p> <p>Results</p> <p>Improvements in waiting and lead times (19-24%) were achieved and sustained in the two years following lean-inspired changes to employee roles, staffing and scheduling, communication and coordination, expertise, workspace layout, and problem solving. These changes resulted in improvement because they: (a) standardized work and reduced ambiguity, (b) connected people who were dependent on one another, (c) enhanced seamless, uninterrupted flow through the process, and (d) empowered staff to investigate problems and to develop countermeasures using a "scientific method". Contextual factors that may explain why not even greater improvement was achieved included: a mismatch between job tasks, licensing constraints, and competence; a perception of being monitored, and discomfort with inter-professional collaboration.</p> <p>Conclusions</p> <p>Drawing on Spear and Bowen's theoretical propositions, this study explains how a package of lean-like changes translated into better care process management. It adds new knowledge regarding how lean principles can be beneficially applied in healthcare and identifies changes to professional roles as a potential challenge when introducing lean thinking there. This knowledge may enable health care organizations and managers in other settings to configure their own lean program and to better understand the reasons behind lean's success (or failure).</p

Swedish healthcare management practices and quality improvement work: development trends

Purpose – The purpose of this paper is to empirically examine developmental trends in healthcare organisation management practice and improvement work. Design/methodology/approach – Primary healthcare centre (n ¼ 1; 031) and clinical hospital department (n ¼ 1; 542) managers were surveyed in spring 2007 (response rate 46 per cent). This article compares results from this survey with a study in 2003. A theoretical framework based on organisational inner context, organisational outer context, external environment and outcomes form the analytical base. Comparisons were made using independent two-sample t-tests. Findings – A general aspect, identified empirically, is the tendency toward increased external pressure on leaders in their improvement work. Higher management decisions, patient pressure and decisions made by policymakers increasingly influence and shape the choices made by healthcare managers about where to focus improvement efforts. Three different trends are empirically identified and elaborated: take-control logic; practice-based improvement; and patient-centeredness. Research limitations/implications – Healthcare leaders should carefully design new management control systems that support healthcare micro systems. Findings support the general assumption that staff increasingly tend to focus organisational changes on management control. Originality/value – This study extends management research with a unique survey. Through two measurements made in 2003 and 2007, several important trends about how healthcare organisations are managed and developed are identified