1
|
Hedsköld M, Sachs MA, Rosander T, von Knorring M, Pukk Härenstam K. Acting between guidelines and reality- an interview study exploring the strategies of first line managers in patient safety work. BMC Health Serv Res 2021; 21:48. [PMID: 33419431 PMCID: PMC7796601 DOI: 10.1186/s12913-020-06042-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 12/22/2020] [Indexed: 11/10/2022] Open
Abstract
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. METHODS Interview study with first line managers in intensive care units in eight different hospitals located in the middle of Sweden. An inductive qualitative content analysis approach was used, this was then followed by a deductive analysis of the strategies informed by constructs from High reliability organizations. RESULTS We present how first line managers view their role in patient safety and exemplify concrete strategies by which managers promote patient safety in everyday work. CONCLUSIONS Our study shows the central role of front-line managers in organizing for safe care and creating a culture for patient safety. Although promoted widely in Swedish healthcare at the time for the interviews, the HSOPSC was not mentioned by the managers as a central source of information on the unit's safety culture.
Collapse
Affiliation(s)
- Mats Hedsköld
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Magna Andreen Sachs
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Torleif Rosander
- Department of Anaesthesiology and intensive care, Södersjukhuset, Stockholm Region, Sweden
| | - Mia von Knorring
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Karin Pukk Härenstam
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, 171 77, Stockholm, Sweden. .,Department of Paediatric Emergency Care, Astrid Lindgren's Children's' Hospital, Karolinska University Hospital, Stockholm, Stockholm Region, Sweden.
| |
Collapse
|
2
|
Sparring V, Granström E, Andreen Sachs M, Brommels M, Nyström ME. One size fits none - a qualitative study investigating nine national quality registries' conditions for use in quality improvement, research and interaction with patients. BMC Health Serv Res 2018; 18:802. [PMID: 30342511 PMCID: PMC6195992 DOI: 10.1186/s12913-018-3621-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 10/10/2018] [Indexed: 11/10/2022] Open
Abstract
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. The aim was further to identify potential differences between various types of NQRs for their use in these areas. METHODS In this multiple case study, nine NQRs were purposively selected. Interviews (n = 18) were conducted and analysed iteratively using conventional and directed content analysis. RESULTS A recent national investment initiative enabled more intensive work with development areas previously identified by the NQR management teams. The recent focus on value-based health care and other contemporary national healthcare investments aiming at QI and public benchmarking were perceived as facilitating factors. Having to perform double registrations due to shortcomings in digital systems was perceived as a barrier, as was the lack of authority on behalf of the registry management to request participation in NQRs and QI activities based on registry outcomes. The registry management teams used three strategies to enhance the use of NQRs: ensuring registering of correct and complete data, ensuring updated and understandable information available for patients, clinicians, researchers and others stakeholders, and intensifying cooperation with them. Varied characteristics of the NQRs influenced their use, and the possibility to reach various end-users was connected to the focus area and context of the NQRs. CONCLUSIONS The recent national investment initiative contributed to already ongoing work to strengthen the use of NQRs. To further increase the use, the demands of stakeholders and end-users must be in focus, but also an understanding of the NQRs' various characteristics and challenges. The end-users may have in common a need for training in the methodology of registry based research and benchmarking, and how to be more patient-centred.
Collapse
Affiliation(s)
- Vibeke Sparring
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE-17177, Stockholm, Sweden.
| | - Emma Granström
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE-17177, Stockholm, Sweden
| | - Magna Andreen Sachs
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE-17177, Stockholm, Sweden
| | - Mats Brommels
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE-17177, Stockholm, Sweden
| | - Monica E Nyström
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE-17177, Stockholm, Sweden.,Department of Public health and Clinical medicine, Epidemiology and Global health, Umeå University, SE-90187, Umeå, Sweden
| |
Collapse
|
3
|
Klinga C, Hasson H, Andreen Sachs M, Hansson J. Understanding the dynamics of sustainable change: A 20-year case study of integrated health and social care. BMC Health Serv Res 2018; 18:400. [PMID: 29866114 PMCID: PMC5987399 DOI: 10.1186/s12913-018-3061-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 03/26/2018] [Indexed: 11/10/2022] Open
Abstract
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. However, previous research has focused on the initiation, resistance and implementation of change, while longitudinal studies remain sparse. The objective of this study was therefore to gain insight into the dynamics of sustainable changes in integrated health and social care through an analysis of local actions that were triggered by a national policy. METHODS A retrospective and qualitative case-study research design was used, and data from the model organisation's steering-committee minutes covering 1995-2015 were gathered and analysed. The analysis generated a narrative case description, which was mirrored to the key elements of the Dynamic Sustainability Framework (DSF). RESULTS The development of inter-sectoral cooperation was characterized by a participatory approach in which a shared structure was created to support cooperation and on-going quality improvement and learning based on the needs of the service user. A key management principle was cooperation, not only on all organisational levels, but also with service users, stakeholder associations and other partner organisations. It was shown that all these parts were interrelated and collectively contributed to the creation of a structure and a culture which supported the development of a dynamic sustainable health and social care. CONCLUSION This study provides valuable insights into the dynamics of organizational sustainability and understanding of key managerial actions taken to establish, develop and support integration of health and social care for people with complex mental health needs. The service user involvement and regular reviews of service users' needs were essential in order to tailor services to the needs. Another major finding was the importance of continuously adapting the content of the change to suit its context. Hence, continuous refinement of the change content was found to be more important than designing the change at the pre-implementation stage.
Collapse
Affiliation(s)
- Charlotte Klinga
- Department of Learning, Informatics, Management and Ethics (LIME), Medical Management Centre (MMC) | Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Henna Hasson
- Department of Learning, Informatics, Management and Ethics (LIME), Medical Management Centre (MMC) | Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Magna Andreen Sachs
- Department of Learning, Informatics, Management and Ethics (LIME), Medical Management Centre (MMC) | Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Johan Hansson
- Department of Learning, Informatics, Management and Ethics (LIME), Medical Management Centre (MMC) | Karolinska Institutet, 171 77 Stockholm, Sweden
| |
Collapse
|
4
|
Andreen Sachs M, Pukk Härenstam K. [Patient involvement in patient safety]. Lakartidningen 2017; 114:ELXX. [PMID: 28485772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
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.
Collapse
Affiliation(s)
- Magna Andreen Sachs
- Karolinska Institutet - institutionen för lärande, informatik, Stockholm, Sweden LIME/MMC - Karolinska institutet Stockholm, Sweden
| | | |
Collapse
|
5
|
Wahlberg Å, Andreen Sachs M, Bergh Johannesson K, Hallberg G, Jonsson M, Skoog Svanberg A, Högberg U. Self-reported exposure to severe events on the labour ward among Swedish midwives and obstetricians: A cross-sectional retrospective study. Int J Nurs Stud 2016; 65:8-16. [PMID: 27815987 DOI: 10.1016/j.ijnurstu.2016.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 10/19/2016] [Accepted: 10/21/2016] [Indexed: 10/20/2022]
Abstract
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. DESIGN Cross-sectional survey. PARTICIPANTS Members of the Swedish Association of Midwives (SFB) and the Swedish Society of Obstetrics and Gynaecology (SFOG). METHODS A questionnaire covering demographic characteristics, experiences of self-reported severe events on the delivery ward, and complaints of medical negligence was developed. Potential consequences of the complaint was not reported. A severe event was defined as: 1) the death of an infant due to delivery-related causes during childbirth or while on the neonatal ward; 2) an infant being severely asphyxiated or injured at delivery; 3) maternal death; 4) very severe or life threatening maternal morbidity; or 5) other stressful events during delivery, such as exposure to violence or aggression. RESULTS The response rate was 39.9% (n=1459) for midwives and 47.1% (n=706) for obstetricians. Eighty-four percent of the obstetricians and almost 71% of responding midwives had experienced one or more self-reported severe obstetric event with detrimental consequences for the woman or the new-born. Fourteen percent of the midwives and 22.4% of the obstetricians had faced complaints of medical negligence from the patient or the family of the patient. CONCLUSIONS A considerable proportion of midwives and obstetricians will, in the course of their working life, experience severe obstetric events in which the mother or the new-born is injured or dies. Preparedness for such exposure should be part of the training, as should managerial and peer support for those in need. This could prevent serious consequences for the health care professionals involved and their subsequent careers.
Collapse
Affiliation(s)
- Åsa Wahlberg
- Department of Women's and Children's Health/Obstetrics & Gynecology, Uppsala University, Sweden; Department of Gynecology and Obstetrics, Skåne University Hospital, Malmö, Sweden.
| | | | | | - Gunilla Hallberg
- Department of Women's and Children's Health/Obstetrics & Gynecology, Uppsala University, Sweden; Department of Gynecology and Obstetrics, Akademiska Hospital, Uppsala, Sweden
| | - Maria Jonsson
- Department of Women's and Children's Health/Obstetrics & Gynecology, Uppsala University, Sweden; Department of Gynecology and Obstetrics, Akademiska Hospital, Uppsala, Sweden
| | - Agneta Skoog Svanberg
- Department of Women's and Children's Health/Obstetrics & Gynecology, Uppsala University, Sweden
| | - Ulf Högberg
- Department of Women's and Children's Health/Obstetrics & Gynecology, Uppsala University, Sweden
| |
Collapse
|
6
|
Klinga C, Hansson J, Hasson H, Sachs MA. Co-Leadership - A Management Solution for Integrated Health and Social Care. Int J Integr Care 2016; 16:7. [PMID: 27616963 PMCID: PMC5015547 DOI: 10.5334/ijic.2236] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 05/11/2016] [Indexed: 11/20/2022] Open
Abstract
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. METHOD Interviews with eight managers exercising co-leadership were analysed using directed content analysis. Respondent validation was conducted through additional interviews with the same managers. RESULTS Key contextual preconditions were an organization-wide model supporting co-leadership and co-location of services. Perception of the management role as a collective activity, continuous communication and lack of prestige were essential personal and interpersonal preconditions. In daily practice, office sharing, being able to give and take and support each other contributed to provision of sustainable integration of health and social care. CONCLUSION AND DISCUSSION Co-leadership promoted robust management by providing broader competence, continuous learning and joint responsibility for services. Integrated health and social care services should consider employing co-leadership as a managerial solution to achieve sustainability.
Collapse
Affiliation(s)
- Charlotte Klinga
- Medical Management Centre (MMC), Department of Learning, Informatics,
Management and Ethics, Karolinska Institutet, SE
- Department of Social Work, Karolinska University Hospital, SE
| | - Johan Hansson
- Medical Management Centre (MMC), Department of Learning, Informatics,
Management and Ethics, Karolinska Institutet, SE
| | - Henna Hasson
- Medical Management Centre (MMC), Department of Learning, Informatics,
Management and Ethics, Karolinska Institutet, SE
- Centre for Epidemiology and Community Medicine, Stockholm County
Council, SE
| | - Magna Andreen Sachs
- Medical Management Centre (MMC), Department of Learning, Informatics,
Management and Ethics, Karolinska Institutet, SE
| |
Collapse
|
7
|
Andreen Sachs M. [She fought for world peace and better living conditions for all]. Lakartidningen 2016; 113:DUHC. [PMID: 26928684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Magna Andreen Sachs
- Karolinska Institutet - institutionen för lärande, informatik, Stockholm, Sweden LIME/MMC - Karolinska institutet Stockholm, Sweden
| |
Collapse
|
8
|
Lindh M, Bergens A, Andreen Sachs M. [When the behavior becomes a patient safety risk]. Lakartidningen 2015; 112:DFI6. [PMID: 25965651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
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. Dealing with the problem requires acknowledgement of its existence, and international examples have shown how to identify and prevent disruptive behaviour among health care staff.
Collapse
Affiliation(s)
| | | | - Magna Andreen Sachs
- Karolinska Institutet - institutionen för lärande, informatik, Stockholm, Sweden LIME/MMC - Karolinska institutet Stockholm, Sweden
| |
Collapse
|
9
|
Sharp L, Klinga C, Hansson J, Sachs MA. [Electronic health records risk patient safety. Audit of medical records shows serious deficiencies in documentation]. Lakartidningen 2014; 111:868-871. [PMID: 24908801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
|
10
|
Abstract
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. Methods 21 healthcare professionals at a Swedish university hospital who each had experienced an adverse event were interviewed. Data from semi-structured interviews were analysed by qualitative content analysis using QSR NVivo software for coding and categorisation. Results Our findings confirm earlier studies showing that emotional distress, often long-lasting, follows from adverse events. In addition, we report that the impact on the healthcare professional was related to the organisation’s response to the event. Most informants lacked organisational support or they received support that was unstructured and unsystematic. Further, the formal investigation seldom provided adequate and timely feedback to those involved. The insufficient support and lack of feedback made it more difficult to emotionally process the event and reach closure. Discussion This article addresses the gap between the second victim's need for organisational support and the organisational support provided. It also highlights the need for more transparency in the investigation of adverse events. Future research should address how advanced support structures can meet these needs and provide learning opportunities for the organisation. These issues are central for all hospital managers and policy makers who wish to prevent and manage adverse events and to promote a positive safety culture.
Collapse
Affiliation(s)
- Susanne Ullström
- Department of Learning, Informatics, Management and Ethics (LIME), Medical Management Centre (MMC), Karolinska Institutet, , Stockholm, Sweden
| | | | | | | | | |
Collapse
|
11
|
Hedsköld M, Pukk-Härenstam K, Berg E, Lindh M, Soop M, Øvretveit J, Andreen Sachs M. Psychometric properties of the Hospital Survey on Patient Safety Culture, HSOPSC, applied on a large Swedish health care sample. BMC Health Serv Res 2013; 13:332. [PMID: 23964867 PMCID: PMC3765335 DOI: 10.1186/1472-6963-13-332] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 08/17/2013] [Indexed: 11/28/2022] Open
Abstract
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. METHODS The questionnaire was mainly administered in web form and 84215 forms were returned (response rate 60%) between 2009 and 2011. Eleven per cent of the responses came from primary care workers and 46% from hospital care workers. The psychometric properties were analyzed using both the total sample and the hospital and primary care subsamples by assessment of construct validity and internal consistency. Construct validity was assessed by confirmatory (CFA) and exploratory factor (EFA) analyses and internal consistency was established by Cronbachs's α. RESULTS CFA of the total, hospital and primary care samples generally showed a good fit while the EFA pointed towards a 9-factor model in all samples instead of the 14-dimension S-HSOPSC instrument. Internal consistency was acceptable with Cronbach's α values above 0.7 in a major part of the dimensions. CONCLUSIONS The S-HSOPSC, consisting of 14 dimensions, 48 items and 3 single-item outcome measures, is used both in hospitals and in primary care settings in Sweden for different purposes. This version of the original American instrument has acceptable construct validity and internal consistency when tested on large datasets of first-time responders from both hospitals and primary care centres. One common instrument for measurements of patient safety culture in both hospitals and primary care settings is an advantage since it enables comparisons between sectors and assessments of national patient safety improvement programs. Future research into this version of the instrument includes comparing results from patient safety culture measurements with other outcomes in relation to safety improvement strategies.
Collapse
Affiliation(s)
- Mats Hedsköld
- Medical Management Centre, Karolinska Institutet, SE 171 77 Stockholm,
Sweden
| | - Karin Pukk-Härenstam
- Medical Management Centre, Karolinska Institutet, SE 171 77 Stockholm,
Sweden
- Astrid Lindgren´s Childrens´ Hospital, Karolinska University
Hospital, SE 171 76 Stockholm, Sweden
| | - Elisabeth Berg
- Medical Management Centre, Karolinska Institutet, SE 171 77 Stockholm,
Sweden
| | - Marion Lindh
- Public Healthcare Services Committee Administration, Stockholm County
Council, Box 6909, SE 102 39 Stockholm, Sweden
| | - Michael Soop
- National Board of Health and Welfare, SE 106 30 Stockholm, Sweden
| | - John Øvretveit
- Medical Management Centre, Karolinska Institutet, SE 171 77 Stockholm,
Sweden
| | - Magna Andreen Sachs
- Medical Management Centre, Karolinska Institutet, SE 171 77 Stockholm,
Sweden
| |
Collapse
|
12
|
Sachs MA, Baehrendtz S, Sellgren SF, Ullström S, Øvretveit J. [Staff who have been involved in adverse events is left without help. Systematic support from colleagues and managers is desirable, according to interview study]. Lakartidningen 2013; 110:550-552. [PMID: 23596846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Magna Andreen Sachs
- Institutionen för lärande, informatik, management och etik, Medical Management Centre, Karolinska institutet.
| | | | | | | | | |
Collapse
|
13
|
Øvretveit J, Sachs MA. [Improvement work can create value with clever leadership. Research can show the way in times of economic crisis]. Lakartidningen 2010; 107:764-766. [PMID: 20402268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
|
14
|
Lindh M, Vanhala J, Tolf S, Øvretveit J, Sachs MA. [Beneficial improvement work with common clinical problems]. Lakartidningen 2009; 106:3168-3173. [PMID: 20077642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Marion Lindh
- Landstingsstyrelsens förvaltning, Stockholms läns landsting.
| | | | | | | | | |
Collapse
|
15
|
Sachs MA. [Remains to prove if "lean thinking" is beneficial for health care]. Lakartidningen 2009; 106:373. [PMID: 19297817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
|
16
|
Lindh M, Wallin CJ, Götmark H, Sachs MA. [American care providers create support for safe health care]. Lakartidningen 2008; 105:3744-3746. [PMID: 19278098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Marion Lindh
- Centrum för vårdutveckling, Stockholms läns landsting.
| | | | | | | |
Collapse
|
17
|
Sachs MA. [Without will--no safe health care. World-famous Americans demand more potent safety work, Sweden should follow]. Lakartidningen 2005; 102:2538-9. [PMID: 16200899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
|
18
|
Ovretveit J, Sachs MA. [Quality and shortages of patient safety--how reduce the costs?]. Lakartidningen 2005; 102:232-4. [PMID: 15743134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
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. The article presents research which shows subjects and services where there is evidence both of poor quality and of effective interventions The article shows ways systematically to incorporate economic considerations into decisions about improvement and practical methods for estimating the costs of a quality problem and possible savings. A simple method is presented which would allow a purchaser or provider to make a comprehensive overview of a range of healthcare problems to help decide where to invest resources to save costs. Economic criteria and estimates, however, should not be the only criteria for selecting improvement subjects. Understanding of the costs of both the problem and the solution would encourage more effective quality and safety improvement and provide one way of measuring the progress of an action to solve the problem.
Collapse
Affiliation(s)
- John Ovretveit
- Medical Management Centrum, Karolinska Institutet, Bergen, Norge
| | | |
Collapse
|
19
|
Ovretveit J, Sachs MA. [Patient safety and quality problems--what is the cost?]. Lakartidningen 2005; 102:140-2. [PMID: 15712739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
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. Adverse drug events account for a major part of the problem and have been estimated to be approximately 1.5% of the UK NHS annual budget. Other quality deficiency problems that have been costed in various studies are the use of inefficient medical procedures, hospital acquired infections and variation in clinical practice. There are only a few studies reporting the effectiveness of different actions to reduce adverse events and waste, and even less evidence about the cost of these different interventions. There is, however, sufficient evidence to suggest certain actions would not only relieve considerable patient suffering, but would make significant economic savings for health care and society. When planning for interventions to improve quality and reduce safety deficiencies, the costs of the problem should be calculated and weighed against the costs of the intervention, i.e the "quality cost" should be estimated. It should be decided how a potential saving could be retained by a unit which has invested in such an intervention. The third article describes methods for estimating quality costs in health care.
Collapse
Affiliation(s)
- John Ovretveit
- Medical management centrum, Karolinska institutet, Bergen, Norge
| | | |
Collapse
|
20
|
Ovretveit J, Sachs MA. [Quality and shortages of patient safety--how big is the problem?]. Lakartidningen 2005; 102:45-8. [PMID: 15707107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
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. Research has discovered high rates of "adverse events" in health care services. The actual rate varies depending on definition, methods of measurement, and type of service. Rates as high as 46% of patients admitted to hospital have been reported. Sometimes high reported rates indicate that a service is serious about collecting data, rather than being an unsafe service. Generally, half of the events can be classified as "avoidable", and a significant proportion as "serious" causing death, disability or a longer hospital stay. Adverse drug events account for a high proportion and are probably the most well studied of patient safety problems. Although most of the current research has been done in the US, there is some evidence which suggests that problems within Swedish health care are of a similar magnitude and type. This article summarises the main studies and focuses on evidence of the economic consequences of deficiencies in patient safety and quality.
Collapse
|
21
|
Sachs MA. [High price to be paid when safety in health care is insufficient]. Lakartidningen 2004; 101:1158-9. [PMID: 15101239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
|
22
|
Sachs MA, Wallstedt L. [Organ procurement activities at the Karolinska University Hospital are going on]. Lakartidningen 2004; 101:615. [PMID: 15024881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
|
23
|
Wiklund I, Lindvall K, Sachs MA. [The county of Stockholm pays for home childbirth in certain cases. Strict medical criteria and requirements when it comes to midwives must be fulfilled]. Lakartidningen 2003; 100:4272-7. [PMID: 14756089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
|
24
|
Andreen Sachs M, Theodorsson E. [Comprehensive quality indicators for health care services]. Lakartidningen 2002; 99:797, 800, 803. [PMID: 11894621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
On behalf of the Swedish government, the National Board of Health and Welfare recently issued a recommended set of 60 quality indicators for broad monitoring of the quality of national health care. This initiative is in concordance with similar international initiatives. The Swedish process, however, is unique in the sense that the professions have developed the indicator and more than 40 national quality registers already monitor most of them. Health care professionals in Sweden have a long-standing tradition of measuring and monitoring results including comparing the quality of different health providers by means of the quality registers. However, the transparency by which these measures are presented, the general understanding of how such data should be interpreted and used in practice is as yet not sufficiently developed. Transparency of data combined with knowledgeable interpretation by health professionals will provide patients with sound information about health care quality and the necessary prerequisites for making comparisons between providers. It will also help guiding managers and politicians making decisions. In order to reach this objective, close co-operation between patient organisations, health care managers and the professionals is needed including a common understanding of the needs and perspectives of all parties.
Collapse
|
25
|
Wesbury SA, Mosher JE, Sachs MA. Continuing education: an approach toward structure and a call for help. Hosp Health Serv Adm 2001; 23:68-78. [PMID: 10308283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
|
26
|
Sachs MA, Svensson C, Synnerman JE, Olsson J. [Traditional quality assurance is not enough! Focusing on the patient demands modern, learning-based development]. Lakartidningen 2000; 97:3380-3. [PMID: 11016201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- M A Sachs
- Institutionen för konstruktions- och produktionsteknik, avdelningen för kvalitetsteknik, Linköpings universitet
| | | | | | | |
Collapse
|
27
|
Sachs MA. [Life help or death help? Sedation is a veiled euthanasia during terminal care]. Lakartidningen 1999; 96:4053-4. [PMID: 10526469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Affiliation(s)
- M A Sachs
- Socialstyrelsens vetenskapliga råd, Landstingsförbundet, Stockholm
| |
Collapse
|
28
|
Sachs MA. Three strategies to improve market share and gain competitive advantage. Healthc Strateg 1999; 3:1-6. [PMID: 10537875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
|
29
|
Sachs MA, Synnerman JE. [Quality registries are a gold-mine of information that should be better used. Knowledge of improvement is acquired by means of special projects]. Lakartidningen 1999; 96:2438-40. [PMID: 10380485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
|
30
|
Sachs MA. Managed care: the next generation. Front Health Serv Manage 1998; 14:3-26. [PMID: 10169548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Managed care today affects most Americans. Of the 160 million Americans receiving employee coverage, 120 million are in a managed care setting. HMO development to date has been driven by the desire to reduce health benefit costs for employers. Employees, the real consumers, perceive a clash between "good care and good profits." Health plans have generated profits by reducing utilization and keeping a portion of the savings. In the future, market conditions will force plans to develop new ways of maintaining profitability. Also, plans will survive by focusing on factors that matter most to consumers-such as overall care quality and access. Care systems that combine the benefits of open-access systems with the benefits of point-of-service products represent the next generation of consumer-driven healthcare.
Collapse
|
31
|
Sachs MA. Economic dislocation's trickle-down impact for health providers. Health Care Strateg Manage 1995; 13:12-3. [PMID: 10144163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
|
32
|
Sachs MA, Pickens GT. What members want. HMO 1995; 36:21-4. [PMID: 10153114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
One large multi-market study recently confirmed that people are more satisfied in HMOs than they are in other types of health plans--and the results have nothing to do with health status. Here's a look at what drives HMO member satisfaction.
Collapse
Affiliation(s)
- M A Sachs
- Sachs Group, Inc., Evanston, IL, USA
| | | |
Collapse
|
33
|
Sachs MA. Collaboration versus competition: letting the natural order work. Front Health Serv Manage 1995; 10:40-2. [PMID: 10132492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
|
34
|
Sachs MA. Healthcare information needs in the '90s. Comput Healthc 1989; 10:43-4. [PMID: 10296313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
|
35
|
Abstract
Neural tissue tumors of the oral cavity are rare. They are found most commonly in the tongue and arise from the sheaths of peripheral nerves, neuroglia, and neurons. We report magnetic resonance findings in a case of neurilemoma of the tongue.
Collapse
Affiliation(s)
- F W Flickinger
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City 52242
| | | | | | | |
Collapse
|
36
|
Sachs MA, Bonney RS, Blumberg CS. Pricing for successful contracting. How to gain negotiating leverage with purchasers. Healthc Exec 1988; 3:18-21. [PMID: 10302699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
|