Search results

It seems impossible to create a comprehensive evaluation model which fully takes into account the multi‐dimensional context of integrated health and social care. Clinical integration, as a prerequisite for efficient outcomes of integration, must nonetheless get special attention. For more extensive evaluations, a quality chain matrix, including co‐operating acts by different providers, has proven to be useful. Examples of evaluated services in Sweden are given, and the management benefits of the use of evaluation data are highlighted.

The purpose of this paper is to explore the concepts of Swedish integrated health care, their state of development and interdependence, and, furthermore, evaluate whether the theoretical framework used improves the comprehension of why integrated health care arrangements endure or cease.

The study is founded on descriptive data gathered from a literature search on integrated health care in Sweden. With inspiration from ecology theory, these data were analysed guided by a theoretical model based on a continuum of symbiotic effects, from antagonism to mutualism.

The era of Swedish integrated health care started in the 1990s, when a kind of clinical network called chains of care was launched. At the beginning the chain of care development was predominantly surrounded by non‐integrative conditions, which had a restraining effect on these efforts. Even so, it seems that chains of care are here to stay. This faith in chains of care can to some extent be explained by the crucial role they have as connectors in the emerging local health care systems. Thus, these systems need chains of care to evolve and chains of care seem to require the integrative framework of local health care to progress and endure. Integrated health care performance could be troublesome, unless such mutualistic conditions are in place. States of commensalism may also be promoted, but the advantages are unilateral and therefore there is a risk of disloyalty by the unaffected part, which, in turn, can create a breeding‐ground for an antagonistic liaison.

A theoretical approach founded on what may be called “Health Care System Ecology” appears to enhance the understanding of the complex logic of integrated health care.

The purpose of this paper is to identify what is practiced during collaboration exercises and possible facilitators for inter-organisational collaboration.

Interviews with 23 participants from four collaboration exercises in Sweden were carried out during autumn 2011. Interview data were subjected to qualitative content analysis.

Findings indicate that the exercises tend to focus on intra-organisational routines and skills, rather than developing collaboration capacities. What the participants practiced depended on roles and order of arrival at the exercise. Exercises contributed to practicing leadership roles, which was considered essential since crises are unpredictable and require inter-organisational decision making.

The results of this study indicate that the ability to identify boundary objects, such as injured/patients, was found to be important in order for collaboration to occur. Furthermore, lessons learned from exercises could benefit from inter-organisational evaluation. By introducing and reinforcing certain elements and distinct aims of the exercise, the proactive function of collaboration exercises can be clarified.

Swedish healthcare has undergone continuous development over several decades. Today, legal responsibility is shared on the local and regional levels, i.e. between municipalities and county councils. The purpose of the present study is to gain a deeper understanding of boundary spanning roles and strategies involved in municipal and county council collaboration. A grounded theory approach was used. Fifteen informants from several Swedish health care authorities were interviewed. A tension exists between preserving boundary strategies that stifle collaboration and boundary spanning strategies that facilitate it. The way boundary spanners manage their role is assumed to influence the centre of gravity for this tension and thus the combination of favourable boundary spanning strategies and favourable boundary spanning roles is one way of getting the current form of collaboration to work.

In order to shorten the response time, two part-time fire departments (FDs) in Sweden initialize a first incident person (FIP) assignment. This is done by alarming the crew manager as an FIP, responding in a separate emergency vehicle, and by arriving at the scene before rest of the crew. The purpose of this paper is to explore and describe experiences of the FIP assignment within an FD.

A multimethod design was used, influenced by Creswell and Plano Clark’s (2011) explanatory sequential mixed method design including emergency reports, a questionnaire and interviews.

The results show that the FIP assignment was a function that secured an early presence at the scene of an accident or emergency situations, which is beneficial for society in the form of a safety factor, for the firefighters in the form of early prior information on what to expect at the scene and for the patient in the form of early existential support and increased chances of survival.

In order to prevent full scenarios to happen and get the chance to save lives, an early response must be ensured. Hence, studies must be made in different settings, based on its unique conditions. This study indicates that by implementing FIP in FDs placed in a rural area, the FIP can break the chain of events and becoming a new link in the chain of survival.