Papers by Andreas Hellström
한국품질경영학회 추계학술발표논문집, 2015
Purpose-Quality improvement programs are still quite rare in healthcare, and often healthcare pro... more Purpose-Quality improvement programs are still quite rare in healthcare, and often healthcare professionals that are given roles like-quality managers‖,-organization development‖ or-improvement leaders‖ do not have a common understanding of a basic underlying theory of quality improvement. As Deming, inspired by the pragmatic philosopher C I Lewis, said:-Without a theory experiences teaches nothing‖. In 2003 the Division of Quality Sciences at Chalmers was asked to provide a common theory to quality managers and improvement leaders-an academic course (30 ECTS) was created. Based on the very positive responses from the participants of this course and their employers we decided to create a Centre for Healthcare Improvement (CHI) at Chalmers with a focus on research and education with a pronounced objective to make a difference to healthcare organizations especially in the region of Västra Götaland. From these experiences we want to suggest that education could be used as a catalyst for healthcare transformation. Methodology-Since the starting point of the educational initiative in 2004 we have followed the development of improvement activities and educational initiatives in the surrounding healthcare system, i.e. the Västra Götaland region with special emphasis on the Skaraborg hospital group and the Regional Cancer Centre Väst as cases. Findings-Education has been at the core of the initiative at CHI and a lot of improvement activities have been catalysed through the course participants and their organizations. A research program with an action research profile supporting healthcare transformation has been created. The education together with this research has created a snowball effect leading to many improvement projects and a shift towards an improvement, process oriented and customer/patient focused culture in the participating healthcare organizations. Originality-In today´s search for remedies of the emerging health care crisis new ways of improving healthcare are needed. Education has been suggested as an important possibility. However, few long term results have been published-especially not long term effects from continual education in improvement science. The contribution herein gives a contribution to the literature on improvement science and corresponding education initiatives.
BMJ Open Quality, 2019
BackgroundThe need for training in quality improvement for healthcare staff is well acknowledged,... more BackgroundThe need for training in quality improvement for healthcare staff is well acknowledged, but long-term outcomes of such training are hard to evaluate. Behaviour change, improved organisational performance and results are sought for, but these variables are complex, multifactorial and difficult to assess.AimThe purpose of this article is to explore the personal and organisational outcomes identified by participants over 14 years of university-led QI courses for healthcare professionals.MethodInspired by the Kirkpatrick model for evaluation, we used concept mapping, a structured mixed method that allows for richness of data to be captured and visualised by inviting stakeholders throughout the process. In total, 331 previous course participants were included in the study by responding to two prompts, and 19 stakeholders taking part in the analysis process by doing the sorting.ResultTwo maps, one for personal outcomes and one for organisational outcomes, show clusters of the re...
British Journal of Management, Nov 27, 2021
There is consensus that complex problems of contemporary society call for public service collabor... more There is consensus that complex problems of contemporary society call for public service collaborations. So-called public service logic (PSL) focuses on joint value creation among a multiplicity of actors in service ecosystems. Despite recognizing various actors, this logic is essentially user-centric, with the service user being the one realizing the value. Consequently, single and collaborating organizations cannot deliver value, only potential value, or so-called value propositions. The elusive public service logic takes a network value configuration for granted and as a starting point. Drawing from two cases in Swedish healthcare, this paper argues that two other value configurations (chain and shop) are also relevant for understanding the development of value propositions-and that these may be related to both intra-and inter-organizational processes. Theoretically, we conclude that just like public service logic, other collaborative public management theories need to recognize the importance of a multiplicity of value configurations and that these are often related to both intra-and inter-organizational processes. We conclude that managers should not adopt the latest network trends without first reflecting on the relevance of existing internal processes.
Public Money & Management
The traditional public service ethos needs to be challenged by including citizens/users in develo... more The traditional public service ethos needs to be challenged by including citizens/users in developing and improving public services. However, the often one-sided positive accounts of co-production, codesign and co-innovation risk public managers and policy-makers involving citizens/users when it may be inappropriate and/or cause more harm than good. This article explains these 'co-concepts' and suggests how managers and policy-makers should balance the positive with potential negative (disvalue) aspects to enable a more useful practice of citizen/user involvement.
BMC Health Services Research
BackgroundDemands for both customization and standardization are increasing in healthcare. At the... more BackgroundDemands for both customization and standardization are increasing in healthcare. At the same time, resources are scarce, and healthcare managers are urged to improve efficiency. A framework of threevalue configurations– shop, chain, and network – has been proposed for how healthcare operations can be designed and organized for efficient value creation. In this paper, use of value configurations for balancing of standardization and customization is explored in the context of care for chronic mental conditions.MethodsA typical case is presented to illustrate the manifestations of conflicting demands between customization and standardization, and the potential usefulness of the value configurations framework. Qualitative data were collected from managers and care developers in two focus groups and six semi-structured interviews, completed by a national document describing a care pathway. Data were coded and analysed using an insider-outsider approach.ResultsOperationalization...
Public Money & Management, 1970
This deliverable aims at identifying the variables to be considered in order to describe the Busi... more This deliverable aims at identifying the variables to be considered in order to describe the Business Model (BM) of a digital solution used for assisting elderly people with Mild Cognitive Impairments (MCI). The objective is reached through an analysis of relevant literature, case studies, good practices and key trends related to digital service solutions explored through Co-Creation Workshops (CCWs) organised with patients, caregivers and physicians. The analysis centered around the identification of the most suitable papers/projects/experiences, focusing on the most relevant variables for providing social-care services – enabled by digital solutions – to the specific segment of users tackled by the DECI Project. Four interrelated domains – service, technology, organisation and finance – are considered in order to gain a holistic view of the key points characterizing the BM, with respect to the STOF framework. The analysis is the focalized thanks to the use of the Business Model Ca...
Alternative Value Configuration Models in Healthcare and Its Effect on Professional Fulfillment
In the last years, a variety of theoretical frameworks have been proposed to support decision-mak... more In the last years, a variety of theoretical frameworks have been proposed to support decision-makers while assessing eHealth initiatives. These frameworks aim at guaranteeing a rational, efficient and fair assessment to select those initiatives that are value-for-money. This study, by means of a systematic literature review, investigates the actual application of the theoretical frameworks when assessing eHealth initiatives. Results show that empirical studies do not rely on theoretical frameworks and prefer tailor-made approaches, thus reducing the comparability of current assessments.
International Journal of Health Governance, 2020
PurposeThe purpose of this paper is to empirically explore and demonstrate the ability of healthc... more PurposeThe purpose of this paper is to empirically explore and demonstrate the ability of healthcare professionals to attain professional fulfilment when providing healthcare inspired by “value shops”.Design/methodology/approachA qualitative case study incorporating interviews and observations was conducted.FindingsThe empirical data suggest that the professional fulfilment of both physicians and nurses is facilitated when care is organized through “value shops”. Both groups of professionals state that they are able to return to their “professional core”.Originality/valueThe beneficial outcomes of organizing healthcare inspired by the “value shop” have previously been explored in terms of efficiency and quality. However, the professional fulfilment of healthcare professionals when providing such care has not been explicitly addressed. Professional fulfilment is vital in order to safeguard high-quality care, as well as healthcare professionals' involvement and engagement in imple...
BMC Health Services Research, 2018
Background: Interest in the implementation of various innovations (e.g. medical interventions and... more Background: Interest in the implementation of various innovations (e.g. medical interventions and organizational approaches) has increased rapidly, and management innovations (MIs) are considered particularly complex to implement. In contrast to a traditional view that innovations are implemented, some scholars have promoted the view that innovations are translated into contexts, a view referred to as translation theory. The aim of this paper is to investigate how a translation theory perspective can inform the Consolidated Framework of Implementation Research (CFIR) to increase understanding of the complex process of putting MIs into practice. The empirical base is a two-year implementation of the MI Value-Based Health Care (VBHC) to a psychiatric department in a large Swedish hospital. Methods: In this longitudinal case study, a qualitative approach was applied using an insider researcher with unique access to data, who followed the implementation starting in 2015. Data sources includes field notes, documents, and audio recordings of meetings and group reflections which were abridged into an event data file structured by CFIR domains. In a joint analysis, an outsider researcher was added to strengthen the analysis and mitigate potential bias. Results: Two themes were identified, for which CFIR did not satisfactorily explain the findings. First, the intervention characteristics (i.e. the content of the MI) were modified along the process and, second, the process did not follow predefined plans. However, the project was still perceived to be successful by internal and external stakeholders. Conclusions: The paper proposes three ways in which translation theory can inform CFIR when applied to MIs: 1) strength of evidence is not as important for MIs as for medical and technical innovations; 2) adaptability of the MI can be emphasized more strongly, and 3) it can be more fruitful to view implementation as a dynamic process rather than seeing it as a matter of planning and execution. For managers, this implies encouragement to seize the opportunity to translate MIs to fit their organization, rather than to aim to be true to an original concept.
Total Quality Management & Business Excellence, 2019
This study explores the various roles of quality departments and investigates whether their roles... more This study explores the various roles of quality departments and investigates whether their roles have different influence on business results. Based on a survey of quality managers in 211 Swedish organisations, the analysis identifies four roles of quality departments: firefighters, auditors, process improvers, and orchestrators. The roles vary in their predominant adoption of Quality Management practices ranging from a narrow scope focusing on quality management systems to a broader scope, based on multiple practices. An analysis was performed to identify how each of the identified roles influences business results. The results show that quality departments with a broad focus, combining both explorative and exploitative quality practices, contribute the most to business results.
Journal of Health Organization and Management, 2017
Purpose The concept of value is becoming increasingly fashionable in healthcare and various impro... more Purpose The concept of value is becoming increasingly fashionable in healthcare and various improvement approaches (IAs) have been introduced with the aim of increasing value. The purpose of this paper is to construct a taxonomy that supports the management of parallel IAs in healthcare. Design/methodology/approach Based on previous research, this paper proposes a taxonomy that includes the dimensions of view on value and organizational focus; three contemporary IAs – lean, value-based healthcare, and patient-centered care – are related to the taxonomy. An illustrative qualitative case study in the context of psychiatric (psychosis) care is then presented that contains data from 23 interviews and focuses on the value concept, IAs, and the proposed taxonomy. Findings Respondents recognized the dimensions of the proposed taxonomy and indicated its usefulness as support for choosing and combining different IAs into a coherent management model, and for facilitating dialog about IAs. The...
International journal for equity in health, Jan 24, 2016
In light of the growing emphasis on individualization in healthcare, it is vital to take the dive... more In light of the growing emphasis on individualization in healthcare, it is vital to take the diversity of inhabitants and users into consideration. Thus, identifying shared perceptions among group members may be important in improving healthcare that is relevant to the particular group, but also perceptions of the staff with whom interactions take place. This study investigates how motherhood is perceived among three groups: Somali-born mothers; Swedish-born mothers; and nurses at Swedish child health centers. Inequities in terms of access and satisfaction have previously been identified at the health centers. Participants in all three groups were asked to finalize two statements about motherhood; one statement about perfect motherhood, another about everyday motherhood. The responses were analyzed using qualitative coding and categorization to identify differences and similarities among the three groups. The responses to both statements by the three groups included divergences as w...
Management ideas are an important part of every organization’s institutional environment. These i... more Management ideas are an important part of every organization’s institutional environment. These ideas affect how organizations are managed by shaping managers’ understanding of what organizations can, may or must do. Consequently, the diffusion and adoption of management ideas is an important aspect in the understanding of why organizations take certain actions at certain points in time. Furthermore, it is important to better understand how organizations mobilize to make their management ideas real and what processes they go through in their progress from general idea to local practice. The overall purpose of this thesis is to contribute to existing empirical insight and knowledge about factors that are influential in the process during which management ideas are put into practice in an organizational context. The six appended papers highlight various aspects and phases of this process. The first study investigated managers’ perceptions of improvement work in the Swedish healthcare system. The second study investigated the introduction of a new model for working hours in a Swedish production plant. The last four investigated different phases in the diffusion and adoption of process management. One of these papers deals with the discourse of process management in management journals. The other three focus on the adoption of process management in a part of the public sector and on actions taken by the receiving end of management ideas. The results draw special attention to the tacit nature of management ideas and the conceptual ambiguity that makes it difficult to pinpoint their exact meaning. Thus different interpretations are possible and one idea can be given various meanings according to the subjective perceptions of the members of an organization. The thesis further illustrates that the adoption process is a process of considerable disequilibrium since it is a situation in which elements of power and politics in the organization are manifested. Hence, it is suggested that adoption of management ideas is better seen as contextualized into the organizations rather than being implemented according to plan. Since this contextualization determines what meaning the idea that is implemented can attain, the thesis argues that it also determines the potential level of change and thus has a direct effect on the level of improvements in organizational performance.
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Papers by Andreas Hellström