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The establishment and expansion of an innovative centre for rational pharmacotherapy--determinants and challenges.

https://arctichealth.org/en/permalink/ahliterature278872
Source
Int J Health Plann Manage. 2015 Jan-Mar;30(1):14-30
Publication Type
Article
Author
Therese Kardakis
Göran Tomson
Björn Wettermark
Mats Brommels
Brian Godman
Pia Bastholm-Rahmner
Source
Int J Health Plann Manage. 2015 Jan-Mar;30(1):14-30
Language
English
Publication Type
Article
Keywords
Decision Support Systems, Clinical - organization & administration
Drug Therapy - methods
Health facilities
Health Facility Administration
Humans
Interdisciplinary Communication
Leadership
Organizational Innovation
Program Development
Program Evaluation
Sweden
Abstract
The regional Board of Health in Stockholm, Sweden, established the Pharmacotherapy Centre (PTC) to enhance the rational use of medicines. The PTC initiated computerised decision support systems and developed a range of electronic service products to sustain rational prescribing. However, knowledge about which determinants have supported or hindered the sustainability of this type of healthcare organisation is limited.
This study aims to identify and explore determinants that support or challenge the development and sustainability of the PTC organisation, as well as investigate the key elements of their implementation efforts.
An in-depth interview study among key informants involved in the establishment of the PTC organisation was conducted. Data were analysed using qualitative content analysis.
Findings suggest that determinants enabling the development and expansion of this organisation include the presence of innovative characteristics among the PTC leadership and the ability of leaders to nurture visionary innovation in others, as well as the instigation of informal social networks and to identify end-user needs. Challenges included an ambiguous relationship to the pharmaceutical industry, an underestimation of the innovation-system fit and to undertake systematic evaluation of created impact by the organisation. Although prescriber use of electronic service products and adherence to an essential drug list increased over time, it remains difficult to identify methods required for demonstrating patient effects.
Whereas some determinants enabled the successful expansion of the PTC organisation, others served to substantially hinder it. The determinants identified can pave the way for systematic investigations into organisational change and development research in the pharmaceutical field.
PubMed ID
23785014 View in PubMed
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Evolution and outcomes of a quality improvement program.

https://arctichealth.org/en/permalink/ahliterature142979
Source
Int J Health Care Qual Assur. 2010;23(3):312-27
Publication Type
Article
Date
2010
Author
Johan Thor
Bo Herrlin
Karin Wittlöv
John Øvretveit
Mats Brommels
Author Affiliation
The Medical Management Centre, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden. johan.thor@ki.se
Source
Int J Health Care Qual Assur. 2010;23(3):312-27
Date
2010
Language
English
Publication Type
Article
Keywords
Female
Hospital Departments - organization & administration
Hospitals, University - organization & administration
Humans
Leadership
Male
Organizational Case Studies
Outcome and Process Assessment (Health Care) - organization & administration
Quality Assurance, Health Care - organization & administration
Quality Indicators, Health Care
Sex Factors
Sweden
Time Factors
Abstract
The purpose of this paper is to examine the outcomes and evolution over a five-year period of a Swedish university hospital quality improvement program in light of enduring uncertainty regarding the effectiveness of such programs in healthcare and how best to evaluate it.
The paper takes the form of a case study, using data collected as part of the program, including quality indicators from clinical improvement projects and participants' program evaluations.
Overall, 58 percent of the program's projects (39/67) demonstrated success. A greater proportion of projects led by female doctors demonstrated success (91 percent, n=11) than projects led by male doctors (51 percent, n=55). Facilitators at the hospital continuously adapted the improvement methods to the local context. A lack of dedicated time for improvement efforts was the participants' biggest difficulty. The dominant benefits included an increased ability to see the "bigger picture" and the improvements achieved for patients and employees.
Quality measurement, which is important for conducting and evaluating improvement efforts, was weak with limited reliability. Nevertheless, the present study adds evidence about the effectiveness of healthcare improvement programs. Gender differences in improvement team leadership merit further study. Improvement program evaluation should assess the extent to which improvement methods are locally adapted and applied.
This case study reports the outcomes of all improvement projects undertaken in one healthcare organization over a five-year period and provides in-depth insight into an improvement program's changeable nature.
PubMed ID
20535903 View in PubMed
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Implementing clinical guidelines in psychiatry: a qualitative study of perceived facilitators and barriers.

https://arctichealth.org/en/permalink/ahliterature98307
Source
BMC Psychiatry. 2010;10:8
Publication Type
Article
Date
2010
Author
Tord Forsner
Johan Hansson
Mats Brommels
Anna Aberg Wistedt
Yvonne Forsell
Author Affiliation
Department of Public Health Sciences, Karolinska Institutet, Stockholm SE-171 76, Sweden. tord.forsner@ki.se
Source
BMC Psychiatry. 2010;10:8
Date
2010
Language
English
Publication Type
Article
Keywords
Adult
Attitude of Health Personnel
Evidence-Based Medicine - standards
Female
Focus Groups - methods
Guideline Adherence - organization & administration - standards
Humans
Leadership
Male
Middle Aged
Practice Guidelines as Topic - standards
Professional Practice - standards
Psychiatry - standards
Qualitative Research
Quality of Health Care - standards
Questionnaires
Sweden
Abstract
BACKGROUND: Translating scientific evidence into daily practice is complex. Clinical guidelines can improve health care delivery, but there are a number of challenges in guideline adoption and implementation. Factors influencing the effective implementation of guidelines remain poorly understood. Understanding of barriers and facilitators is important for development of effective implementation strategies. The aim of this study was to determine perceived facilitators and barriers to guideline implementation and clinical compliance to guidelines for depression in psychiatric care. METHODS: This qualitative study was conducted at two psychiatric clinics in Stockholm, Sweden. The implementation activities at one of the clinics included local implementation teams, seminars, regular feedback and academic detailing. The other clinic served as a control and only received guidelines by post. Data were collected from three focus groups and 28 individual, semi-structured interviews. Content analysis was used to identify themes emerging from the interview data. RESULTS: The identified barriers to, and facilitators of, the implementation of guidelines could be classified into three major categories: (1) organizational resources, (2) health care professionals' individual characteristics and (3) perception of guidelines and implementation strategies. The practitioners in the implementation team and at control clinics differed in three main areas: (1) concerns about control over professional practice, (2) beliefs about evidence-based practice and (3) suspicions about financial motives for guideline introduction. CONCLUSIONS: Identifying the barriers to, and facilitators of, the adoption of recommendations is an important way of achieving efficient implementation strategies. The findings of this study suggest that the adoption of guidelines may be improved if local health professionals actively participate in an ongoing implementation process and identify efficient strategies to overcome barriers on an organizational and individual level. Getting evidence into practice and implementing clinical guidelines are dependent upon more than practitioners' motivation. There are factors in the local context, e.g. culture and leadership, evaluation, feedback on performance and facilitation, -that are likely to be equally influential.
PubMed ID
20089141 View in PubMed
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Simulation team training for improved teamwork in an intensive care unit.

https://arctichealth.org/en/permalink/ahliterature115186
Source
Int J Health Care Qual Assur. 2013;26(2):174-88
Publication Type
Article
Date
2013
Author
Christer Sandahl
Helena Gustafsson
Carl-Johan Wallin
Lisbet Meurling
John Øvretveit
Mats Brommels
Johan Hansson
Author Affiliation
Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
Source
Int J Health Care Qual Assur. 2013;26(2):174-88
Date
2013
Language
English
Publication Type
Article
Keywords
Communication
Humans
Inservice Training - organization & administration
Intensive Care Units - organization & administration
Leadership
Organizational Case Studies
Patient Care Team - organization & administration
Patient Safety
Personnel Staffing and Scheduling
Sweden
Abstract
This study aims to describe implementation of simulator-based medical team training and the effect of this programme on inter-professional working in an intensive care unit (ICU).
Over a period of two years, 90 percent (n = 152) of the staff of the general ICU at Karolinska University Hospital, Huddinge, Sweden, received inter-professional team training in a fully equipped patient room in their own workplace. A case study method was used to describe and explain the planning, formation, and results of the training programme.
In interviews, the participants reported that the training had increased their awareness of the importance of effective communication for patient safety. The intervention had even had an indirect impact by creating a need to talk, not only about how to communicate efficaciously, but also concerning difficult care situations in general. This, in turn, had led to regular reflection meetings for nurses held three times a week. Examples of better communication in acute situations were also reported. However, the findings indicate that the observed improvements will not last, unless organisational features such as staffing rotas and scheduling of rounds and meetings can be changed to enable use of the learned behaviours in everyday work. Other threats to sustainability include shortage of staff, overtime for staff, demands for hospital beds, budget cuts, and poor staff communication due to separate meetings for nurses and physicians.
The present results broaden our understanding of how to create and sustain an organizational system that supports medical team training.
PubMed ID
23534151 View in PubMed
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