The purpose of this paper is to explore the different subcultures and the employees' preparedness for change at an orthopaedic clinic in a university hospital in Sweden.
Surveys were sent out to 179 nurses and physicians. The survey included the two instruments Organisational Values Questionnaire and resistance to change (RTC) Scale.
The results suggest a dominance of a human relations culture, i.e. flexibility, cohesion and trust, in the orthopaedic clinic. These characteristics seemed to decrease RTC. Opposite to this, planning, routines and goal setting appeared to increase change-resistant behaviour.
By predicting potential obstacles in a certain context prior to a change process, resources can be used in a more optimal way. An instrument that pinpoints the culture of a particular healthcare setting may be a useful tool in order to anticipate the possible outcome of change.
The rational goal/internal processes dimension exerted a stronger association with RTC than in earlier studies. Deeply rooted standards and routinised care models, governed by work schedules, could be an obstacle to introducing a care model based on the individual needs of the patient. There was, however, a surprisingly low RTC. The results are contrary to the accepted understanding of public organisations known to be slow to change.
The current global security threats indicate a need for a change in the Swedish defense policies including the role of civilian and military healthcare in an armed conflict. The magnitude, outcome and management of the recent terror and mass casualty incidents in Europe necessitate a closer Swedish civilian-military collaboration. However, in reality, such a collaboration might be more difficult than expected. The aim of this article is to comment on some of the critical points of such collaboration from a civilian perspective.
It is well known that a conservative organizational culture can hinder the implementation of new organizational models. Prior to introducing something new it is important to identify the culture within the organization. This paper sets out to detect the feasibility of reform in a psychiatric clinic in a Swedish hospital prior to implementation of a new working method - a structured tool based on the International Classification of Functioning Disability and Health. A survey consisting of two instruments - an organizational values questionnaire (OVQ) and a resistance to change scale (RTC) - was distributed to registered and assistant nurses at the clinic. The association between the organizational subcultures and resistance to change was investigated with regression analysis. The results revealed that the dominating cultures in the outpatient centers and hospital wards were characterized by human relation properties such as flexibility, cohesion, belongingness, and trust. The mean resistance to change was low, but the subscale of cognitive rigidity was dominant, reflecting a tendency to avoid alternative ideas and perspectives. An instrument like the one employed in the study could be a useful tool for diagnosing the likelihood of extensive and costly interventions.
To explore community nurses' experiences of decision making within the community provider organization.
Recent changes in health care with an increasing number of patients being cared for outside of institutions can put considerable pressure on the nurse with respect to decision making.
In-depth interviews were performed with 6 registered nurses in two communities. The interviews were analysed by means of phenomenological hermeneutics.
The community nurses' experiences of decision making were interpreted as spiders or octopuses, consultants and troubleshooters. The subthemes were; networking and structuring, responsibility, availability and knowledge, assessment power, information selection, avoiding rules and bypassing managers. In accordance with hermeneutical phenomenology, the findings were discussed and explained with reference to Ofstad's philosophy of freedom to make decisions.
In their decision making, community nurses are committed to finding administrative solutions that satisfy patient needs.
Historical changes have transformed Sweden from being an offensive to a defensive and collaborative nation with national and international engagement, allowing it to finally achieve the ground for the civilian-military collaboration and the concept of a total defense healthcare. At the same time, with the decreasing number of international and interstate conflicts, and the military's involvement in national emergencies and humanitarian disaster relief, both the need and the role of the military healthcare system within the civilian society have been challenged. The recent impact of the COVID-19 in the USA and the necessity of military involvement have led health practitioners to anticipate and re-evaluate conditions that might exceed the civilian capacity of their own countries and the need to have collaboration with the military healthcare. This study investigated both these challenges and views from practitioners regarding the benefits of such collaboration and the manner in which it would be initiated.
A primary study was conducted among responsive countries using a questionnaire created using the Nominal Group Technique. Relevant search subjects and keywords were extracted for a systematic review of the literature, according to the PRISMA model.
The 14 countries responding to the questionnaire had either a well-developed military healthcare system or units created in collaboration with the civilian healthcare. The results from the questionnaire and the literature review indicated a need for transfer of military medical knowledge and resources in emergencies to the civilian health components, which in return, facilitated training opportunities for the military staff to maintain their skills and competencies.
As the world witnesses a rapid change in the etiology of disasters and various crises, neither the military nor the civilian healthcare systems can address or manage the outcomes independently. There is an opportunity for both systems to develop future healthcare in collaboration. Rethinking education and training in war and conflict is indisputable. Collaborative educational initiatives in disaster medicine, public health and complex humanitarian emergencies, international humanitarian law, and the Geneva Convention, along with advanced training in competency-based skill sets, should be included in the undergraduate education of health professionals for the benefit of humanity.
Head and neck cancer and its treatment deteriorate quality of life, but symptoms improve with person-centred care. We examined the cost-effectiveness of a person-centred care intervention versus standard medical care.
In this randomized clinical trial of a person-centred intervention, patients were planned for outpatient oncology treatment in a Swedish university hospital between 2012 and 2014 and were followed during 1 year. Annual healthcare costs were identified from medical records and administrative register data. Productivity costs were calculated from reported sick leave. Health-related quality of life was collected using the EuroQol Group's five-dimension health state questionnaire.
Characteristics were similar between 53 patients in the intervention group and 39 control patients. The average total cost was Euro (EUR) 55,544 (95% confidence interval: EUR 48,474-62,614) in the intervention group and EUR 57,443 (EUR 48,607-66,279) among controls, with similar health-related quality of life.
This person-centred intervention did not result in increased costs and dominated the standard medical care.
To examine the impact of a simulation training in raising a group of young students' personal and situational awareness in disasters and emergencies.
In total, 25 young students participated in two simulation scenarios representing two actual events, fire, and shooting, using a combination of two validated simulation training (Emergency Management and Preparedness Training for Youth [EMPTY]). The changes in their knowledge and awareness were evaluated by using questionnaires and the whole simulation was evaluated by three independent observers and a reference group.
New concepts of emergency management, for example, evacuation, and barricading, could be trained in a safe environment. There was a significant increase in students' personal and situational awareness and their active engagement in the management of emergencies.
EMPTY could raise the youth basic knowledge and ability to understand the concept of preparedness by being mentally prepared, available for collaboration, gaining a higher confidence, understanding the physical and psychological consequences of a major incident and the importance of their own safety. (Disaster Med Public Health Preparedness. 2018;12:685-688).
Single responder (SR) systems have been implemented in several countries. When the very first SR system in Sweden was planned, it was criticised because of concerns about sending single emergency nurses out on alerts. In the present study, the first Swedish SR unit was studied in order to register waiting times and assess the working environment.
Quantitative data were collected from the ambulance dispatch register. Data on the working environment were collected using a questionnaire sent to the SR staff.
The SR system reduced the average patient waiting time from 26 to 13min. It also reduced the number of ambulance transports by 35% following triage of patient(s) priority determined by the SR. The staff perceived the working environment to be adequate.
The SR unit was successful in that it reduced waiting times to prehospital health care. Contrary to expectations, it proved to be an adequate working environment. There is good reason to believe that SR systems will spread throughout the country. In order to enhance in depth the statistical analysis, additional should be collected over a longer time period and from more than one SR unit.
The aim of this exploratory case study was to examine whether sensemaking processes may influence decision-making of emergency call center dispatchers when dealing with maritime crises. This article focuses on sensemaking and decision-making in an emergency services context using Norwegian operators as a case and reports on data collected from five focus-group interviews with emergency dispatchers at five different locations. Each focus group consisted of three dispatchers, representing the three main Norwegian emergency response dispatch centers: police, fire and rescue, and the Emergency Medical Communication Centre (AMK). The study's purpose was to see whether choices made when responding to maritime crisis calls are influenced by sensemaking processes, and whether these processes may have influenced the dispatcher's choice of which search and rescue resources to contact. The study found that the sensemaking processes that occurred prior to the decision-making might have been influenced by the dispatcher's past experiences, in particular, experiences from land-based operations. The findings also suggested that the emergency dispatchers made decisions based on intuitive sensemaking, as they were perceived pressed on time and experienced maritime crisis in a more transboundary nature than everyday land-based emergencies. The effects of sensemaking processes and intuitive decision-making shown in this study are of possible relevance to emergency services educators and managers outside a Norwegian framework.
To measure the effect of organizational culture on health outcomes of patients 3 months after discharge.
a quantitative study using Organizational Values Questionnaire (OVQ) and a health-related quality of life instrument (EQ-5D). A total of 117 nurses, 69% response rate, and 220 patients answered the OVQ and EQ-5D, respectively.
The regression analysis showed that; 16% (R(2) = 0.02) of a decreased health status, 22% (R(2) = 0.05) of pain/discomfort and 13% (R(2) = 0.02) of mobility problems could be attributed to the combination of open system (OS) and Human Relations (HR) cultural dimensions, i.e., an organizational culture being dominated by flexibility.
The results from the present study tentatively indicated an association between an organizational culture and patients' health related quality of life 3 months after discharge. Even if the current understanding of organizational culture, which is dominated by flexibility, is considered favourable when implementing a new health care model, our results showed that it could be hindering instead of helping the new health care model in achieving its objectives.