Building sustainable hospitals: A resource interaction perspective

In response to a growing influence of patients, higher specialisation, technological advancement and the need to provide care services more efficiently, the issue of sustainability in healthcare has gained prominence. The purpose of this paper is to investigate how the social and economic sustainability of healthcare are dependent on interconnecting resources across organisational borders and in different settings over time. Adopting a product development process perspective, the paper explores the gap between a planned healthcare facility and how it actually came to be used, through a longitudinal case study of the Skandion clinic, a small, highly specialised, hospital in Sweden. The findings suggests that integration of healthcare resources over time is central to achieve social and economic sustainability goals. The results hereby contend the prevailing view of hospitals as independent organisational units and highlights the need for more holistic analyses of sustainability in healthcare. Analyses which take into account the complex interdependencies stretching across networks of interconnected facilities and organisational units

Evidence-based urology in practice : heterogeneity in a systematic review meta-analysis

The definitive version is available at www3.interscience.wiley.com.Peer reviewedPreprin

When construction projects are to satisfy health care needs - partnering as a way of connecting the two?

In the construction industry the intention with partnering is that it should facilitate closer interaction between the client and the project organisation and particularly assist the contractor-client communication. In the Scandinavian countries, a number of high-technology hospitals are currently being planned for and being built through partnering agreements with intentions of providing modern health care supported by advanced medical technology. Health care represents a complex structure of actors, resources and activities that are to be coordinated toward the purpose of providing relevant and consistent care services to individuals over time. The remaining project organisation embodies construction-related organisations that represent a temporarily organised constellation of actors, resources and activities in the design, production and delivery of the building. Thus, as construction “meets” health care in a construction project, there are very different requirements that are to be fulfilled; that of gaining benefits from temporarily organising around a construction project and that of having a facility that supports complex care processes over time. The differences in requirements in turn rests on the different logics of on the one hand temporary and on the other hand permanent organisations of a different set of activities, resources and actors. Through the industrial network approach (INA) we outline the interactions taking place between key actors in a large health care construction project practicing partnering in Sweden, and investigate how partnering affects the communication of these different logics in play. How is the interaction coloured by these different requirements and logics during the different project phases, and what is the role of partnering in creating a favourable setting for useful interaction

"Chorus of the Saved" : Constructing the Holocaust Survivor in Swedish Public Discourse, 1943-1966

In this dissertation I examine how the Holocaust survivor has been constructed in Swedish public discourse during the 1940s, 1950s and 1960s. This is done using a Foucauldian-inspired genealogical method through which an eclectic collection of sources—newsreels, films, radio programs, television programs and newspaper articles—is analyzed. The theoretical underpinnings of this analysis are based on Ian Hacking’s concept of discourse where the classification of survivor ‘types’ has a direct bearing on the expressions possible for those who are classified, i.e. individuals with Holocaust experience. The overarching research question of the dissertation therefore asks: how did a Holocaust survivor ‘type’ develop in Sweden during the 1940s, 50s and 60s?  The main thrust of the argument presented in the dissertation is that the concepts of ‘silence’ and ‘excess’ have always disciplined the ways in which Holocaust survivors have been conceived of as both victims and witnesses in Swedish public discourse. The communication of Jewish suffering by survivor-witnesses has both been framed as a dangerous, destructive force which could instigate unnecessary conflict while it, at the same time, has been positioned as a remedy to collective forgetfulness as well as a solution to rising levels of xenophobia and antisemitism. How survivors have been constructed historically also demonstrates the flawed logic of a historical progressivism within which Holocaust memory is seen to steadily go from silence to interest/increased knowledge. What the research presented in this dissertation shows is that this process is not determined by historical progression but by the underlying problematization of Holocaust survivors’ utility.  

Drivers and Hindrances to Med-Tech Innovation : A device's guide to the Swedish healthcare galaxy

Today, the expectations on new medical technology solutions are substantial. On the one hand, healthcare policy expects new technologies both to improve the quality of people’s life and to reduce the burgeoning healthcare costs. On the other hand, innovation policy expects new med-tech solutions to stimulate economic growth, with large emphasis on the production of new solutions. However, despite the growing importance of med-tech innovations it is cumbersome to embed these innovative promising products into use in the Swedish healthcare sector. This thesis investigates med-tech innovation by following a microwave-based device in the treatment of the common disease BPH, Benign Prostatic Enlargement. This is an empirically based longitudinal study where the microwave device is used as a probe to capture a med-tech innovation journey. We follow the device through the efforts of technological and scientific development, through complex industrial production structures and foremost inits struggles to achieve widespread use in Swedish public healthcare. This study identifies a number of hindrances and drivers and, importantly, how they are interconnected in the innovation process. By applying the different settings of development, production and use of this device, a central finding is that the very same mechanisms can have contradicting effects in the different settings. Moreover, what functions as a trigger to innovation during development, can become later a hindrance to use. The study also shows that, whereas drivers prevail over hindrances in the development and production of med-tech solutions, hindrances clearly prevail in their use, which involves the provision of healthcare services. Not only has the use setting a generally weak financial support, but its organisational structures and regulations do also have a negative impact on the spread of new solutions in healthcare.

Policy options for Nordic collaboration to improve access to antibiotics

Access to antibiotics in the Nordic countries can be jeopardized not only by general factors such as low margins, uncertain volumes, overdependence and fragile supply chains, which can result in missing registration, deregistration and shortages, but also by the small size and fragmented nature of the Nordic markets. Nordic collaboration on specific policies and joint action to address such issues could improve access to antibiotics. Starting from a total of 30 policy options discussed in the literature, this report first selects 10 policies and then identifies 8 prioritized policy options which are presented in a roadmap comprising five waves. The first wave includes improved shortage information and supply chain transparency, a detailed map of production capacity dedicated to the Nordic countries, and common packages and electronic leaflets. The second wave consists of mutual recognition of approvals of old antibiotics and good purchasing practices. The third wave includes new reimbursement models such as revenue guarantees, international stockpiling, and pooled procurement. The fourth wave promotes a production capacity expansion near the Nordic countries,and the fifth wave inside the Nordic countries. Before implementing specific policies, the Nordic countries need to agree on which specific antibiotic products are to be targeted by each policy, which would ideally result in commonly agreed priority lists of clinically relevant products with high supply risk

Implementation of medical technology in management and engineering studies : A systematic literature review and future research agenda

Medical technology is an important part of healthcare and society, and new solutions are needed to meet the demands of aging population and prevalence of chronic diseases. During the last decade considerable technical progression has taken place but implementation of these new solutions is still cumbersome. This study reviews the current state of research within management and engineering studies concerning implementation of medical technology and identifies avenues for further research. A systematic search with keywords such as implementation and medical technology identified 2809 hits of which only ten papers were about implementation of medical technology. This review provides four contributions to research and management: (1) the findings show that there is no field that can be called implementation of medical technology within management and engineering studies, (2) there is no specific journal that publishes research on the topic, (3) majority of the papers are opinion articles and qualitative case studies and (4) many reported barriers to implementation relate to technology. In order to address the complex task of implementing medical technology, management scholars to a larger extent need to acknowledge and study aspects that go beyond technology

Applying the resource interaction approach to policy analysis - Insights from the antibiotic resistance challenge

This paper explores how the Resource Interaction Approach (RIA), namely the 4Rs model and the three settings of developing-producing-using, can be applied to complex policy analyses. We use the global sustainability challenge of antibiotic resistance as an example to define an agenda about how these analytical tools can frame and analyze such problems systematically. We find that these tools offer benefits to policymakers, including flexibility in framing problems, by selecting the focal resources and values to be prioritized, and the ability to visualize the direct and indirect interdependencies that enable or hinder value creation. Moreover, the RIA can point at the resource interfaces that need to change through specific policy interventions, as well as the potential network-level barriers to such changes. We also find that the RIA needs to be complemented by network-level analyses of deal structures and monetary flows in order to better capture the legal and financial dimensions of policy problems and solutions