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Nilsing Strid, E., Wallin, L. & Nilsagård, Y. (2024). Exploring expectations and readiness for healthy lifestyle promotion in Swedish primary health care: a qualitative analysis of managers, facilitators, and professionals. Scandinavian Journal of Primary Health Care, 42(1), 201-213
Open this publication in new window or tab >>Exploring expectations and readiness for healthy lifestyle promotion in Swedish primary health care: a qualitative analysis of managers, facilitators, and professionals
2024 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 42, no 1, p. 201-213Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Prior to a multifaceted implementation strategy for a healthy lifestyle-promoting practice the expectations of primary health care managers, appointed internal facilitators and health care professionals on supporting change was explored.

DESIGN: This study had an explorative qualitative design using data gathered from individual interviews and focus groups. Qualitative content analysis with a deductive category development was applied using the Consolidated Framework for Implementation Research.

SETTING AND PARTICIPANTS: The study was conducted in a primary care setting in central Sweden as a part of the Act in Time research project. Prior to a multifaceted implementation strategy, we held 16 individual interviews with managers and appointed facilitators and five focus groups with 26 health care professionals.

RESULTS: Managers, facilitators, and professionals held similar expectations, where their expressed need for support corresponded to three constructs: Readiness for implementation, Implementation climate, and Engaging. Our findings indicate the need for strong leadership engagement to focus on how the healthy lifestyle-promoting practice can be anchored among the professionals. Managers at all levels should communicate the vision and goals, enable facilitators and professionals to improve their competencies, build inter-professional teams, and jointly plan the new practice.

CONCLUSION: To change to a healthy lifestyle promoting practice professionals request support from their managers, who in turn need support from the middle and top managers. The requested support includes helping to prioritise health promotion and enabling the primary care centres to build competence and take ownership of the implementation.

TRIAL REGISTRATION: ClinicalTrials.gov NCT04799860.

Keywords
Qualitative research, health personnel, healthy lifestyle, implementation science, leadership, practice guidelines, primary health care
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Public Health, Global Health, Social Medicine and Epidemiology Nursing
Identifiers
urn:nbn:se:du-47909 (URN)10.1080/02813432.2023.2301556 (DOI)001145189500001 ()38241166 (PubMedID)2-s2.0-85182677608 (Scopus ID)
Available from: 2024-01-25 Created: 2024-01-25 Last updated: 2024-02-13Bibliographically approved
Rudman, A., Boström, A.-M. -., Wallin, L., Gustavsson, P. & Ehrenberg, A. (2024). The use of the evidence-based practice process by experienced registered nurses to inform and transform clinical practice during the COVID-19 pandemic: A longitudinal national cohort study. Worldviews on Evidence-Based Nursing, 21(1), 14-22
Open this publication in new window or tab >>The use of the evidence-based practice process by experienced registered nurses to inform and transform clinical practice during the COVID-19 pandemic: A longitudinal national cohort study
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2024 (English)In: Worldviews on Evidence-Based Nursing, ISSN 1545-102X, E-ISSN 1741-6787, Vol. 21, no 1, p. 14-22Article in journal (Refereed) Published
Abstract [en]

Background: During the COVID-19 pandemic, many registered nurses (RNs) worked on the frontline caring for severely ill patients. They did so with limited knowledge of how to treat and prevent the disease. This extreme situation puts pressure on RNs to find evidence on which to base the care of their patients. Aims: To examine: (1) the extent to which evidence-based practice (EBP) process was applied by Swedish RN cohorts 15–19 years after graduation during the pandemic, (2) whether there was any change to their EBP process from pre-pandemic to late pandemic, (3) the relationship between RNs' use of the EBP process and the duration of exposure to work situations severely affected by the COVID-19 pandemic, and (4) whether level of education, position and care setting were associated with the extent of RNs' EBP process. Methods: In 2021, the level of EBP activities was investigated among 2237 RNs 15–19 years after graduation. The scale used to measure EBP consisted of six items of the EBP process. Unpaired t-tests or one-way analysis of variance (ANOVA) were used in the analysis. Results: RNs used the EBP process to a moderate extent to inform and transform their clinical practice. There was a minor but significant decrease in practicing the EBP process from pre-pandemic to late in the pandemic. RNs who were most affected by the pandemic scored higher on the scale than less-affected colleagues. RNs in nonclinical positions reported more EBP activities, as did RNs in management positions. RNs working in outpatient settings reported more EBP activities than their colleagues in hospitals. Linking Evidence to Action: It is imperative that RNs hone their skills in EBP if they are to be prepared for future healthcare crises. Healthcare providers have a duty to facilitate the development of EBP and, in this regard, RNs in clinical positions in hospitals need particular support. © 2023 The Authors. Worldviews on Evidence-based Nursing published by Wiley Periodicals LLC on behalf of Sigma Theta Tau International.

Place, publisher, year, edition, pages
John Wiley and Sons Inc, 2024
Keywords
COVID-19 pandemic, evidence-based practice, longitudinal cohort study, registered nurses, repeated measures, survey
National Category
Nursing
Identifiers
urn:nbn:se:du-47509 (URN)10.1111/wvn.12692 (DOI)001123763800001 ()38084830 (PubMedID)2-s2.0-85179311803 (Scopus ID)
Available from: 2023-12-18 Created: 2023-12-18 Last updated: 2024-02-12
Bergström, A., Hoa, D. P., Nga, N. T., Hoa, T., Tu, T. T., Lien, P. T., . . . Eriksson, L. (2023). A facilitated social innovation: stakeholder groups using Plan-Do-Study-Act cycles for perinatal health across levels of the health system in Cao Bang province, Vietnam. Implementation Science Communications, 4, Article ID 24.
Open this publication in new window or tab >>A facilitated social innovation: stakeholder groups using Plan-Do-Study-Act cycles for perinatal health across levels of the health system in Cao Bang province, Vietnam
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2023 (English)In: Implementation Science Communications, E-ISSN 2662-2211, Vol. 4, article id 24Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Universal coverage of evidence-based interventions for perinatal health, often part of evidence-based guidelines, could prevent most perinatal deaths, particularly if entire communities were engaged in the implementation. Social innovations may provide creative solutions to the implementation of evidence-based guidelines, but successful use of social innovations relies on the engagement of communities and health system actors. This proof-of-concept study aimed to assess whether an earlier successful social innovation for improved neonatal survival that employed regular facilitated Plan-Do-Study-Act meetings on the commune level was feasible and acceptable when implemented on multiple levels of the health system (52 health units) and resulted in actions with plausibly favourable effects on perinatal health and survival in Cao Bang province, northern Vietnam.

METHODS: The Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework guided the implementation and evaluation of the Perinatal Knowledge-Into-Practice (PeriKIP) project. Data collection included facilitators' diaries, health workers' knowledge on perinatal care, structured observations of antenatal care, focus group discussions with facilitators, their mentors and representatives of different actors of the initiated stakeholder groups and an individual interview with the Reproductive Health Centre director. Clinical experts assessed the relevance of the identified problems and actions taken based on facilitators' diaries. Descriptive statistics included proportions, means, and t-tests for the knowledge assessment and observations. Qualitative data were analysed by content analysis.

RESULTS: The social innovation resulted in the identification of about 500 relevant problems. Also, 75% of planned actions to overcome prioritised problems were undertaken, results presented and a plan for new actions to achieve the group's goals to enhance perinatal health. The facilitators had significant roles, ensuring that the stakeholder groups were established based on principles of mutual respect. Overall, the knowledge of perinatal health and performance of antenatal care improved over the intervention period.

CONCLUSIONS: The establishment of facilitated local stakeholder groups can remedy the need for tailored interventions and grassroots involvement in perinatal health and provide a scalable structure for focused efforts to reduce preventable deaths and promote health and well-being.

Keywords
Facilitation, Implementation science, Knowledge translation, PDSA cycles, Perinatal health, Social innovation, Vietnam, i-PARIHS
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:du-45653 (URN)10.1186/s43058-023-00403-9 (DOI)36899419 (PubMedID)2-s2.0-85165289275 (Scopus ID)
Available from: 2023-03-16 Created: 2023-03-16 Last updated: 2024-01-08Bibliographically approved
Gyllensten, H., Tistad, M., Fridberg, H. & Wallin, L. (2023). Analysis on personnel costs and working time for implementing a more person-centred care approach: a case study with embedded units in a Swedish region. BMJ Open, 13(10), Article ID e073829.
Open this publication in new window or tab >>Analysis on personnel costs and working time for implementing a more person-centred care approach: a case study with embedded units in a Swedish region
2023 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 13, no 10, article id e073829Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Our aim was to describe the time and costs used during the implementation of a more person-centred care (PCC) approach as part of ordinary practice.

DESIGN: A case study with embedded units.

SETTING: Region Dalarna, Sweden.

PARTICIPANTS: The Department for Development (DD) staff who provided a central support function in the implementation and six healthcare units: nephrology, two geriatric care and rehabilitation units, two psychiatry units and primary care.

INTERVENTIONS: More PCC.

PRIMARY AND SECONDARY OUTCOME MEASURES: Working days and related salary costs reported by categories indicating costs for implementation strategies, service delivery, and research/development costs.

RESULTS: The healthcare units logged on average 5.5 working days per staff member. In the healthcare units, 6%-57% of the time reported was used for implementation strategies, 40%-90% for service delivery and 2%-12% for research/development. Of the time reported by the DD, 88% was assigned to implementation strategies. Costs associated with reported time indicated 23% of costs for this implementation occurred in the DD. Using the budgeted cost, this proportion increased to 48%. The budget for the DD corresponded to SEK 2.30 per citizen per year and 0.009% of the total healthcare budget of the region.

CONCLUSIONS: The study found that a large part of resources used for this implementation of more PCC occurred in the DD, although at least half of the costs occurred in the healthcare units. Moreover, the cost of providing a central support function corresponds to a tiny proportion of the total health budget.

Keywords
HEALTH ECONOMICS, Health economics, Organisational development, Patient-Centered Care
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:du-47116 (URN)10.1136/bmjopen-2023-073829 (DOI)001085223600007 ()37821128 (PubMedID)2-s2.0-85174642171 (Scopus ID)
Available from: 2023-10-18 Created: 2023-10-18 Last updated: 2023-11-17Bibliographically approved
Strid, E. N., Wallin, L. & Nilsagård, Y. (2023). Expectations on implementation of a health promotion practice using individually targeted lifestyle interventions in primary health care: a qualitative study. BMC Primary Care, 24(1), Article ID 122.
Open this publication in new window or tab >>Expectations on implementation of a health promotion practice using individually targeted lifestyle interventions in primary health care: a qualitative study
2023 (English)In: BMC Primary Care, E-ISSN 2731-4553, Vol. 24, no 1, article id 122Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: There is moderate to strong evidence of the effectiveness of health-promotion interventions, but implementation in routine primary health care (PHC) has been slow. In the Act in Time project implementation support is provided for a health promotion practice using individually targeted lifestyle interventions in a PHC setting. Identifying health care professionals' (HCPs') perceptions of barriers and facilitators helps adapt implementation activities and achieve a more successful implementation. This study aimed, at a pre-implementation stage, to describe the expectations of managers, appointed internal facilitators (IFs) and HCPs on implementing a healthy lifestyle-promoting practice in PHC.

METHODS: In this qualitative study five focus group discussions with 27 HCPs and 16 individual interviews with managers and appointed IFs were conducted at five PHC centres in central Sweden. The PHC centres are participating in the Act in Time project, evaluating the process and outcomes of a multifaceted implementation strategy for a healthy lifestyle-promoting practice. A deductive qualitative content analysis based on the Consolidated Framework for Implementation Research (CFIR) was followed using inductive analysis.

RESULTS: Twelve constructs from four of five CFIR domains were derived: Innovation characteristics, Outer setting, Inner setting, and Characteristics of individuals. These domains are related to the expectations of HCPs to implement a healthy lifestyle-promoting practice, which includes facilitating factors and barriers. The inductive analysis showed that the HCPs perceived a need for a health-promotion approach to PHC. It serves the needs of the patients and the expectations of the HCPs, but lifestyle interventions must be co-produced with the patient. The HCPs expected that changing routine practice into a healthy lifestyle-promoting practice would be challenging, requiring sustainability, improved structures, cooperation in inter-professional teams, and a common purpose. A collective understanding of the purpose of changing practice was vital to successful implementation.

CONCLUSIONS: The HCPs valued implementing a healthy lifestyle-promoting practice in a PHC setting. However, changing routine methods was challenging, implying that the implementation strategy should address obstacles and facilitating factors identified by the HCPs.

TRIAL REGISTRATION: This study is part of the Act in Time project, registered in ClinicalTrials.gov with the number NCT04799860 . Registered 03 March 2021.

Keywords
Change Management, Clinical Practice Guidelines, Health Personnel, Healthy Lifestyle, Implementation Science, Primary Health Care, Qualitative Research
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Nursing
Identifiers
urn:nbn:se:du-46251 (URN)10.1186/s12875-023-02079-5 (DOI)001012438000003 ()37328813 (PubMedID)2-s2.0-85162070185 (Scopus ID)
Available from: 2023-06-20 Created: 2023-06-20 Last updated: 2024-04-05Bibliographically approved
Eldh, A. C., Hälleberg-Nyman, M., Joelsson-Alm, E. & Wallin, L. (2023). Facilitating facilitators to facilitate-Some general comments on a strategy for knowledge implementation in health services. Frontiers in health services, 3, Article ID 1112936.
Open this publication in new window or tab >>Facilitating facilitators to facilitate-Some general comments on a strategy for knowledge implementation in health services
2023 (English)In: Frontiers in health services, ISSN 2813-0146, Vol. 3, article id 1112936Article in journal (Refereed) Published
Abstract [en]

Numerous endeavours to ensure that day-to-day healthcare is both evidence-based and person-centred have generated extensive, although partial, comprehension of what guarantees quality improvement. To address quality issues, researchers and clinicians have developed several strategies as well as implementation theories, models, and frameworks. However, more progress is needed regarding how to facilitate guideline and policy implementation that guarantees effective changes take place in a timely and safe manner. This paper considers experiences of engaging and supporting local facilitators in knowledge implementation. Drawing on several interventions, considering both training and support, this general commentary discusses whom to engage and the length, content, quantity, and type of support along with expected outcomes of facilitators' activities. In addition, this paper suggests that patient facilitators could help produce evidence-based and person-centred care. We conclude that research about the roles and functions of facilitators needs to include more structured follow-ups and also improvement projects. This can increase the speed of learning with respect to what works, for whom, in what context, why (or why not), and with what outcomes when it comes to facilitator support and tasks.

Keywords
evidence-based practice, guidelines, internal facilitators, knowledge implementation, leadership, local facilitators
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:du-46001 (URN)10.3389/frhs.2023.1112936 (DOI)001112616800001 ()37138952 (PubMedID)
Available from: 2023-05-09 Created: 2023-05-09 Last updated: 2023-12-22Bibliographically approved
Gustavsson, C., Nordqvist, M., Bergman Bruhn, Å., Bröms, K., Jerdén, L., Kallings, L. V. & Wallin, L. (2023). Process evaluation of an implementation intervention to facilitate the use of the Swedish Physical Activity on Prescription in primary healthcare. BMC Health Services Research, 23(1), Article ID 996.
Open this publication in new window or tab >>Process evaluation of an implementation intervention to facilitate the use of the Swedish Physical Activity on Prescription in primary healthcare
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2023 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, no 1, article id 996Article in journal (Refereed) Published
Abstract [en]

Background The Swedish Physical Activity on Prescription (PAP-S) is a method for healthcare to promote physical activity for prevention and treatment of health disorders. Despite scientific support and education campaigns, the use has been low. The aim of this study was to perform a process evaluation of an implementation intervention targeting the use of the PAP-S method in primary healthcare (PHC). Specifically, we wanted to evaluate feasibility of the implementation intervention, and its effect on the implementation process and the outcome (number of PAP-S prescriptions).

Methods This was a longitudinal study using the Medical Research Council guidance for process evaluation of a 9-month implementation intervention among healthcare staff at three PHC centres in Sweden. Data was collected by: participatory observations of the implementation process; questionnaires to the staff before, after and 6 months after the implementation intervention; interviews after the implementation intervention; and number of PAP-S prescriptions.

Results During the implementation intervention, the workplaces’ readiness-to-change and the healthcare staff’s confidence in using the PAP-S method were favourably influenced, as was the number of PAP-S prescriptions. After the implementation intervention, the number of PAP-S prescriptions decreased to about the same number as before the implementation intervention, at two out of three PHC centres. Four of the six implementation strategies appeared to impact on the implementation process: external facilitation; leadership engagement by a committed workplace management; local PAP-S coordinator taking a leading role and acting as local champion; educational outreach concerning how to use the PAP-S method.

Conclusion The implementation intervention was not sufficient to produce sustained change of the healthcare staff’s behaviour, nor did it achieve favourable long-term outcome on the number of PAP-S prescriptions. The healthcare staffs’ sparse knowledge of the PAP-S method prior to the implementation intervention hampered the implementation. More hands-on education in how to use the PAP-S method introduced early in the implementation process is imperative for successful implementation of the PAP-S method. The findings also suggest that committed workplace management and local PAP-S coordinators, taking leading roles and acting as local champions, need to be firmly established at the PHC centres before the external facilitator withdraws.

Keywords
Disease prevention; Exercise; Health professionals; Health promotion; Implementation; Mixed methods research
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:du-46985 (URN)10.1186/s12913-023-09974-8 (DOI)37715160 (PubMedID)2-s2.0-85171360981 (Scopus ID)
Funder
Uppsala University
Available from: 2023-09-16 Created: 2023-09-16 Last updated: 2023-09-25Bibliographically approved
Squires, J. E., Graham, I. D., Santos, W. J., Hutchinson, A. M., Backman, C., Bergström, A., . . . Watkins, V. (2023). The Implementation in Context (ICON) Framework: A meta-framework of context domains, attributes and features in healthcare. Health Research Policy and Systems, 21(1), Article ID 81.
Open this publication in new window or tab >>The Implementation in Context (ICON) Framework: A meta-framework of context domains, attributes and features in healthcare
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2023 (English)In: Health Research Policy and Systems, E-ISSN 1478-4505, Vol. 21, no 1, article id 81Article in journal (Refereed) Published
Abstract [en]

Background There is growing evidence that context mediates the effects of implementation interventions intended to increase healthcare professionals’ use of research evidence in clinical practice. However, conceptual clarity about what comprises context is elusive. The purpose of this study was to advance conceptual clarity on context by developing the Implementation in Context Framework, a meta-framework of the context domains, attributes and features that can facilitate or hinder healthcare professionals’ use of research evidence and the effectiveness of implementation interventions in clinical practice.

Methods We conducted a meta-synthesis of data from three interrelated studies: (1) a concept analysis of published literature on context (n = 70 studies), (2) a secondary analysis of healthcare professional interviews (n = 145) examining context across 11 unique studies and (3) a descriptive qualitative study comprised of interviews with heath system stakeholders (n = 39) in four countries to elicit their tacit knowledge on the attributes and features of context. A rigorous protocol was followed for the meta-synthesis, resulting in development of the Implementation in Context Framework. Following this meta-synthesis, the framework was further refined through feedback from experts in context and implementation science.

Results In the Implementation in Context Framework, context is conceptualized in three levels: micro (individual), meso (organizational), and macro (external). The three levels are composed of six contextual domains: (1) actors (micro), (2) organizational climate and structures (meso), (3) organizational social behaviour (meso), (4) organizational response to change (meso), (5) organizational processes (meso) and (6) external influences (macro). These six domains contain 22 core attributes of context and 108 features that illustrate these attributes.

Conclusions The Implementation in Context Framework is the only meta-framework of context available to guide implementation efforts of healthcare professionals. It provides a comprehensive and critically needed understanding of the context domains, attributes and features relevant to healthcare professionals’ use of research evidence in clinical practice. The Implementation in Context Framework can inform implementation intervention design and delivery to better interpret the effects of implementation interventions, and pragmatically guide implementation efforts that enhance evidence uptake and sustainability by healthcare professionals.

Keywords
Context, Framework, Healthcare, Implementation, Knowledge translation
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:du-47586 (URN)10.1186/s12961-023-01028-z (DOI)
Available from: 2023-12-27 Created: 2023-12-27 Last updated: 2024-07-04Bibliographically approved
Tistad, M., Bergström, A., Elf, M., Eriksson, L., Gustavsson, C., Göras, C., . . . Wallin, L. (2023). Training and support for the role of facilitator in implementation of innovations in health and community care: a scoping review protocol.. Systematic Reviews, 12(1), Article ID 15.
Open this publication in new window or tab >>Training and support for the role of facilitator in implementation of innovations in health and community care: a scoping review protocol.
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2023 (English)In: Systematic Reviews, E-ISSN 2046-4053, Vol. 12, no 1, article id 15Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Implementing and sustaining innovations in clinical practice, such as evidence-based practices, programmes, and policies, is frequently described as challenging. Facilitation as a strategy for supporting implementation requires a facilitator, i.e. an individual with a designated role to support the implementation process. A growing number of studies report that facilitation can help tackle the challenges in implementation efforts. To optimise the potential contribution of facilitation as a strategy to improve the implementation of new practices, there is a need to enhance understanding about what training and support is required for individuals in the facilitator role. The objective of this scoping review is to map how facilitators have been trained for, and supported in, the facilitator role in implementation studies in health and community care. Specifically, the review aims to examine what is reported on training and support of facilitators in terms of learning outcomes, content, dose, mode of delivery, learning activities, and qualifications of the trainers and how the facilitators perceive training and support.

METHODS: This scoping review will follow the guidance of the Joanna Briggs Institute and the PRISMA Extension for Scoping Review checklist. We will include articles in which (a) facilitation is deployed as an implementation strategy, with identified facilitator roles targeting staff and managers, to support the implementation of specified innovations in health or community care, and (b) training and/or support of facilitators is reported. We will exclude articles where facilitation is directed to education or training in specific clinical procedures or if facilitation supports the implementation of general quality improvement systems. All types of peer-reviewed studies and study protocols published in English will be included. A systematic search will be performed in MEDLINE (Ovid), Embase (embase.com), Web of Science Core Collection, and CINAHL (Ebsco).

DISCUSSION: The proposed scoping review will provide a systematic mapping of the literature on the training and support of implementation facilitators and contribute useful knowledge within the field of implementation science to inform future facilitation initiatives.

SYSTEMATIC REVIEW REGISTRATION: Registered at Open Science Framework (registration https://doi.org/10.17605/OSF.IO/M6NPQ ).

Keywords
Community care, Evidence-based practice, Facilitation, Facilitator, Healthcare services, Implementation science, Supervision, Support, Training, i-PARIHS
National Category
Nursing
Identifiers
urn:nbn:se:du-45393 (URN)10.1186/s13643-023-02172-x (DOI)000924318500001 ()36721192 (PubMedID)2-s2.0-85147186976 (Scopus ID)
Available from: 2023-02-07 Created: 2023-02-07 Last updated: 2023-03-02Bibliographically approved
Tistad, M., Wallin, L. & Carlström, E. (2022). A comparison of three organisational levels in one health care region in Sweden implementing person-centred care: coupled, decoupled or recoupled in a complex organisation. BMC Health Services Research, 22(1), Article ID 196.
Open this publication in new window or tab >>A comparison of three organisational levels in one health care region in Sweden implementing person-centred care: coupled, decoupled or recoupled in a complex organisation
2022 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 22, no 1, article id 196Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Establishing more substantial patient involvement in the health care has become fundamental to Western health care services. Person-centred care (PCC) has been developed as a way of working that involve the patients and family members. However, the implementation of PCC in clinical practice has proven to be challenging. The aim of this study was to explore the congruence of managers' perceptions and understanding of various aspects of PCC across three organisational levels in one health care region in Sweden in terms of coupling, decoupling and recoupling.

METHODS: A policy on increased patient participation in health care was adopted in one health care region in Sweden. This policy was embodied in the form of PCC and a support strategy for the implementation was put in place. Participants representing three organisational levels (senders: politicians, n = 3; messengers: senior management, n = 7; and receivers: middle- and frontline managers, n = 13) were interviewed and documents collected. A deductive qualitative content analysis was performed and findings from the three organisational levels compared.

RESULTS: Descriptions of PCC at all the three organisational levels included health care provided in partnership between provider and patient. However, messengers and receivers also included aspects of how work was organised as part of the concept. Representatives at all levels expected high-quality care while reducing health care costs as an outcome, however, messengers and receivers also anticipated improvements in the work environment and reduced staff turnover. Strategies to support implementation included continuation and enhancement of existing routines that were considered person-centred and development of new ones. A need to make PCC less 'fuzzy' and ambiguous and instead communicate a more tangible care process was described. Representatives among messengers and receivers also suggested that no actions were needed because the practice was already considered person-centred.

CONCLUSION: The findings indicated that congruence between organisational levels existed in some aspects, suggesting coupling between policy and practice. However, also incongruences were identified that might be due to the fuzziness of definitions and the application of PCC in practice, and the difficulty in assessing the level of patient-centredness in clinical practice.

Keywords
Health policy, Implementation, Person-centred care, Spread, Sweden
National Category
Nursing
Identifiers
urn:nbn:se:du-39654 (URN)10.1186/s12913-022-07548-8 (DOI)000756260300009 ()35164765 (PubMedID)2-s2.0-85124621717 (Scopus ID)
Projects
Implementing person-centred care: process evaluation of strategies, leadership and health economy using process evaluation, IMPROVE
Available from: 2022-02-22 Created: 2022-02-22 Last updated: 2023-04-14Bibliographically approved
Projects
iPARIHS och andra implementeringsramverk - en systematisk översiktFacilitera implementeringen av personcentrerad vård
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-9035-0669

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