Who counts when health counts? A case-study of multi-stakeholder initiative to promote value-creation in Swedish healthcare.

A European initiative to design a "medical information framework" conceptualised how multiple stakeholders join in collaborative networks to create innovations. It conveyed the ways in which value is created and captured by stakeholders. We applied those insights to analyse a multi-stakeholder initiative to promote improvement of Swedish healthcare.

Acting between guidelines and reality- an interview study exploring the strategies of first line managers in patient safety work.

Background: Safety culture can be described and understood through its manifestations in the organization as artefacts, espoused values and basic underlying assumptions and is strongly related to leadership-yet it remains elusive as a concept. Even if the literature points to leadership as an important factor for creating and sustaining a mature safety culture, little is known about how the safety work of first line managers' is done and how they balance the different and often conflicting organizational goals in everyday practice. The purpose of this study was to explore how health care first line managers perceive their role and how they promote patient safety and patient safety culture in their units.

One size fits none - a qualitative study investigating nine national quality registries' conditions for use in quality improvement, research and interaction with patients.

Background: Swedish National Quality Registries (NQRs) are observational clinical registries that have long been seen as an underused resource for research and quality improvement (QI) in health care. In recent years, NQRs have also been recognised as an area where patients can be involved, contributing with self-reported experiences and estimations of health effects. This study aimed to investigate what the registry management perceived as barriers and facilitators for the use of NQRs in QI, research, and interaction with patients, and main activities undertaken to enhance their use for these purposes.

Understanding the dynamics of sustainable change: A 20-year case study of integrated health and social care.

Background: Change initiatives face many challenges, and only a few lead to long-term sustainability. One area in which the challenge of achieving long-term sustainability is particularly noticeable is integrated health and social care. Service integration is crucial for a wide range of patients including people with complex mental health and social care needs.

[Patient involvement in patient safety].

Patient involvement in patient safety  The prospect of patients contributing to safer care with their unique knowledge and experiences demands a profound change in roles and attitudes among healthcare staff and researchers. The path forward involves designing ways of coproduction in healthcare quality and safety improvement as well as in research.

Self-reported exposure to severe events on the labour ward among Swedish midwives and obstetricians: A cross-sectional retrospective study.

Background: The process of delivery entails potentially traumatic events in which the mother or child becomes injured or dies. Midwives and obstetricians are sometimes responsible for these events and can be negatively affected by them as well as by the resulting investigation or complaints procedure (clinical negligence).

Objective: To assess the self-reported exposure rate of severe events among midwives and obstetricians on the delivery ward and the cumulative risk by professional years and subsequent investigations and complaints.

Co-Leadership - A Management Solution for Integrated Health and Social Care.

Introduction: Co-leadership has been identified as one approach to meet the managerial challenges of integrated services, but research on the topic is limited. In the present study, co-leadership, practised by pairs of managers - each manager representing one of the two principal organizations in integrated health and social care services - was explored.

Aim: To investigate co-leadership in integrated health and social care, identify essential preconditions in fulfilling the management assignment, its operationalization and impact on provision of sustainable integration of health and social care.

[When the behavior becomes a patient safety risk].

A less discussed aspect of patient safety issues in Sweden has been the correlation between disruptive behaviour and adverse advents. Disruptive behaviour, according to international studies, can affect team collaboration and communication, and hence the safety of care. Disruptive behaviour also exists in Swedish health-care.

Suffering in silence: a qualitative study of second victims of adverse events.

Introduction: The term 'second victim' refers to the healthcare professional who experiences emotional distress following an adverse event. This distress has been shown to be similar to that of the patient-the 'first victim'. The aim of this study was to investigate how healthcare professionals are affected by their involvement in adverse events with emphasis on the organisational support they need and how well the organisation meets those needs.

Psychometric properties of the Hospital Survey on Patient Safety Culture, HSOPSC, applied on a large Swedish health care sample.

Background: A Swedish version of the USA Agency for Healthcare Research and Quality "Hospital Survey on Patient Safety Culture" (S-HSOPSC) was developed to be used in both hospitals and primary care. Two new dimensions with two and four questions each were added as well as one outcome measure. This paper describes this Swedish version and an assessment of its psychometric properties which were tested on a large sample of responses from personnel in both hospital and primary care.

Implementing organisation and management innovations in Swedish healthcare: lessons from a comparison of 12 cases.

Purpose: The purpose of this paper is to compare the implementation of 12 different organisation and management innovations (OMIs) in Swedish healthcare, to discover the generic and specific factors important for successful healthcare improvement change in a public health system.

Design/methodology/approach: Longitudinal cross-case comparison of 12 case studies was employed, where each case study used a common framework for collecting data about the process of change, the content of the change, the context, and the intermediate and final outcomes.

Findings: Clinical leaders played a more important part in the development of these successful service innovations than managers.

[Quality and shortages of patient safety--how reduce the costs?].

There is a sizable "poor quality and safety" problem in health care, not only in terms of suffering to patients but also in economic terms. Few studies have assigned costs to the problems. Decisions about whether to take action and which actions to take would be assisted by economic evidence.

[Patient safety and quality problems--what is the cost?].

Available evidence indicates a sizable "poor quality and safety" problem in health care. Costs can be assigned but few studies have done so. This article, the second in a series of three, summarises research which has calculated the economic cost of these problems.

[Quality and shortages of patient safety--how big is the problem?].

Patient safety is essential to quality health care, to ensure patients are not harmed, but also to ensure that resources are not wasted. More research evidence is becoming available about deficiencies in health care quality and safety. This evidence is reviewed in three consecutive articles in Läkartidningen.