Introduction This realist literature review, regarding active patient involvement in healthcare quality improvement (QI), seeks to identify possible mechanisms that contribute to success or failure. Furthermore, the paper outlines key considerations for organising and supporting patient involvement in healthcare QI efforts.

Methods Two literature searches were performed. Altogether, 1,204 articles from a healthcare context were screened, focusing on improvement efforts that involve patients, healthcare professionals and/or managers and leaders. Among these, 107 articles fulfilled the chosen study selection criteria and were further analysed. 18 articles underwent a full realist review. In the realist synthesis, context-mechanism-outcome configurations were articulated as middle-range theories and organised thematically to generate a program theory on how active patient involvement in QI efforts might work.

Results The articles exhibited a diversity of patient involvement approaches at different levels of healthcare organisations. To be successful, organisations’ support of QI efforts that actively involved patients tailored the QI efforts to their context to achieve the desired outcomes, and involved the relevant microsystem members. Furthermore, it promoted interaction and partnership within the microsystem, and supported the behavioural change that follows.

Conclusion This realist synthesis generates a program theory for active patient involvement in QI efforts; active patient involvement can be a tool (resource), if tailored for interaction and partnership (reasoning), that leads to behaviour change (outcome) within healthcare QI efforts. The theory explains essential resource and reasoning mechanisms, and outcomes that together form guidance for healthcare organisations when managing active patient involvement in QI efforts.

BACKGROUND: Co-production and co-design approaches to quality improvement (QI) efforts are gaining momentum in healthcare. Yet, these approaches can be challenging, not least when it comes to patient involvement. The aim of this study was to examine what might influence QI efforts in which patients are involved, as experienced by the patients and the healthcare professionals involved.

METHODS: This study involved a qualitative design inspired by the constructivist grounded theory. In one mid-sized Swedish hospital's patient process organisation, data was collected from six QI teams that involved patients in their QI efforts, addressing care paths for patients with transient, chronic and/or multiple parallel diagnoses. Field notes were collected from participant observations during 53 QI team meetings in three of the six patient processes. Individual, semi-structured interviews were conducted with 12 patients and 12 healthcare professionals in all the six QI teams.

RESULTS: Patients were involved in QI efforts in different ways. In three of the QI teams, patient representatives attended team meetings regularly. One team consulted patient representatives on a single occasion, one team collected patient preferences structurally from individual interviews with patients, and one team combined interviews and a workshop with patients. The patients' and healthcare professionals' expressions of what might influence the QI efforts involving patients were similar in several ways. QI team members emphasized the importance of organisational structure and culture. Furthermore, they expressed a desire for ongoing interaction between patients and healthcare professionals in healthcare QI.

CONCLUSIONS: QI team members recognised continuous dialogue and collective thinking by the sharing of experiences and preferences between patients and healthcare professionals as essential for achieving better matches between healthcare resources and patient needs in their QI efforts. Significant structural and cultural aspects of performing QI in complex hospital organisations were considered to be obstructions to progress. Therefore, to sustain learning and behaviour change through QI efforts at the team level, a deeper understanding of how structural and cultural aspects of QI promote or prevent success appears essential.

As co-production approaches to quality improvement (QI) gain importance in healthcare, hospital leaders and managers are expected to organise and support such efforts. Yet, patient and public involvement (PPI) can be challenging. Hospital organisations, emphasising knowledge and evidence domains, are characterised by operational-professional rather than patient-preference led management. Thus, PPI adds aspects of influence and responsibility that are not clearly defined or understood, with limited knowledge about how it can be orchestrated. This study, therefore, aimed to explore hospital leaders’ and managers’ contextualised experiences of managing QI efforts involving patients, by comparing two European hospitals.

The study draws on field observations and qualitative interviews with a total of 21 QI team leaders and hospital managers in a Swedish and a Dutch hospital organisation. The data were subjected to thematic analysis with a critical realist approach.

Results define seven themes, or areas, in which mechanisms are at play: (1) patient involvement in hospital QI, and (2) improving outcomes for patients, originating from the strategic view of achieving the hospital vision. Furthermore, (3) societal influence, (4) knowledge and evidence, (5) complexity, (6) individual resources, and (7) cooperation are areas in which mechanisms operate in the process. These areas are equally relevant for both hospitals, yet the mechanisms involved play out differently depending on contextual structure and local means of action.

Ageing population is becoming a major concern because of its economic, political and social impact. Trusted eldercare service is an important issue for a matured nation. The paper addresses the preconditions of healthy ageing and sustainable value integrated eldercare in a developing and a developed society. In India, professional eldercare is about a decade old and is still emerging to get a foothold in the health care system. The aim is to explore understanding and values of home-based eldercare (HBEC) in India from a multiple stakeholder’s perspective and to understand the value related challenges and issues in developments with HBEC in Sweden which has a century old experience of professional and public organised eldercare. The study included 210 in-depth interviews, 105 each from India and Sweden. The in-depth interviews of various stakeholders including older individuals, their relatives, caregivers, managers and doctors. Interviews and focused group discussions were carried out across six cities in India and 10 municipalities in Sweden. The qualitative data were analysed to conceptualise the stakeholders understanding of HBEC, the values associated with care giving, perceived challenges and issues in the emerging HBEC sector in India. The findings highlight the changing values in the societies with relation to the needs and context of eldercare in both countries. These preconditions for compassion and work engagement in care giving as well as competence development in caregivers need to be strengthened in the contexts of care and in alignment with sociocultural values

Objective: to  explore  the  Nordic  municipal  health  and  care  services’  ability  to  promote  principal  goals  within  care  for  older  people  during  the  cOViD-19  pandemic.

Design  and  setting: two  surveys  were  conducted  among  managers  of  municipal  health  care  services  for  older  people  in  Denmark,  Finland,  Norway  and  sweden;  the  first  around  6  months  into  the  pandemic  (survey  1),  and  the  second  around  12  months  later  (survey  2).  Data  were  analysed  through  descriptive  statistics,  and  multiple  regression  (Ols).

Subjects: 1470  (survey  1,  2020)  and  745  (survey  2,  2021)  managers.  32%  in  home  care,  51%  in  nursing  homes,  17%  combined.

Results: in  all  countries  the  pandemic  seems  to  have  had  more  negative  impact  on  eldercare  services’  ability  to  promote  an  active  and  social  life,  than  on  the  ability  to  promote  or  enhance  older  people’s  mental  and  physical  health.  the  regression  analysis  indicates  that  different  factors  influence  the  ability  to  promote  these  goals.  Managers  within  nursing  homes  reported  reduced  ability  to  promote  mental  and  physical  health  and  an  active  social  life  to  a  significantly  lower  degree  than  managers  of  home  care.  the  effect  of  three  prevention  strategies  (lock  down,  testing,  and/or   organisational   change),   were   explored.   Organisational   change   (reorganize   staff   and   practice,  restrict  use  of  substitutes)  tended  to  impact  the  units’  ability  to  promote  a  social  life  in  a  positive  direction,  while  lock  down  (areas,  buffets  etc)  tended  to  impact  both  the  ability  to  promote  mental/physical  health  and  a  social  life  in  a  negative  direction.

Conclusion: Measures   that   can   improve   opportunities   for   an   active   and   social   life   during   a   pandemic  should  have  high  priority,  particularily  within  home  care.

KEY  POINTS

• it  is  important  to  learn  from  how  the  cOViD-19  outbreak  in  2020  affected  the  municipal  health  and  care  services’  ability  to  achieve  principal  goals  within  care  for  older  people.

• the  pandemic  had  a  more  negative  impact  on  the  services’  ability  to  promote  an  active  and  social  life,  than  on  their  ability  to  promote  or  enhance  mental  and  physical  health.

• Measures   that   can   improve   opportunities   for   an   active   and   social   life   during   a   pandemic   situation  should  have  high  priority,  particularily  within  home-based  care.

The aim of this article is to analyse life conditions for families with children and young people with disabilities. Special focus is on: legislation, management and organisations, social support and service, housing, education, work and daily activities and leisure activities. The method used is a case study including interviews with parents and professionals. The study also includes an analysis of documents and regulations. The study shows that the support system is transparent and accessible. At the same time managers in the municipalities' social care services interpret their responsibility in different ways thus affecting the support and service for the families. Even though the families have legal rights to a wide range of support and service, the parents have to work to gain access to these and for user influence to be exerted.

Det övergripande syftet med denna rapport är att beskriva chefers etiska värderingar, dilemman och organisatoriska förutsättningar för att bedriva ett värdebaserat ledarskap i såväl kommunal som privat äldreomsorg.

Det empiriska materialet består av en omfattande enkätstudie till nästan 500 studerande inom ramen för den nationella ledarutbildningen för chefer inom äldreomsorgen vid Högskolan i Borås under perioden 2013 till 2015. Utbildningen gavs på uppdrag av Socialstyrelsen och omfattade 30 högskolepoäng med två års studier på kvartsfart. Samtliga studerande var yrkesverksamma som chefer och ledare inom kommunal eller privat äldreomsorg i södra Sverige. Metoder som använts i bearbetning och analys av materialet är deskriptiva, jämförande och analytiska med regressionsmodeller och SEM-analys.

Resultatet visar på att cheferna – oavsett utbildningsbakgrund, värderade följande etiska värden högst: att inte skada, respekt för individen och rätten till konfidentialitet. Värdedilemman i chefsarbetet är dock vanligt och sammanlänkat med andra utmaningar i arbetet, särskilt med utmaningar som rör hantering över organisationsnivåer (buffertproblem och containerproblem) och av olika ansvarsområden (logikkonflikter). Inom privat verksamhet skattade de medverkande cheferna värdekonflikter och andra utmaningar i lägre grad än chefer inom kommunal verksamhet.

De flesta chefer var nöjda med hur de kunde fullfölja sitt ansvar för utveckling av verksamheten avseende värdegrund, kvalitet, processer, dagligt arbete, brukarmedverkan, brukarsäkerhet och arbetsmiljö. De flesta skattade också att de arbetade i mycket hög grad med strukturering och utveckling av dessa frågor.

Stödresurser minskade upplevelsen av värdekonflikter, men det fanns skillnad i betydelsen relaterat till chefers grundprofession. Det organisatoriska stödet var också tydligare för chefer inom privat verksamhet. Organiserade stödresurser hade stor betydelse för hållbart integrerat och värdeskapande ledarskap samt för aktiva ledningsstrategier. Även sambandet mellan hållbart ledarskap och aktiva ledarstrategier modererades av grundprofession, där sambandet var moderat negativt för chefer med social grundutbildning. Det tycks således finnas ett utbildningsbehov bland äldreomsorgens chefer och behov av ett utvecklat stöd från arbets- HÖGSKOLAN BORÅS HÖGSKOLAN BORÅS 15 givaren då det varierar avseende omfattning, inriktning och nivå mellan kommunal och privat verksamhet.

Sammanfattningsvis har chefer i äldreomsorgen många olika värden, på olika nivåer och utifrån olika perspektiv att förhålla sig till i sitt ledarskap. Att hantera och utveckla förståelse för dessa är utmanande i chefskapet och värdedilemman är vanliga. Majoriteten av cheferna i denna studie beskriver dock generellt en aktiv och god hantering och organisering av dessa. Konstateras att en integrerad förståelse och hantering, samt goda organisatoriska stödresurser tycks bidra till mer hållbart och värdeskapande ledarskap.

The aim of this study was to study interprofessional collaboration in health and social care for older people and persons with disabilities from a care manager's perspective. The empirical data was collected at a workshop held during a national conference for care managers and through focus group interviews in two Swedish municipalities. The results showed that the care managers collaborated in different ways with many different professionals from different organisations. The care and discharge planning meetings emerged as the most typical situation where care managers collaborated with different health care professionals. Interprofessional collaboration was seen as a means for care managers to fulfil their assignment and carry out their work. The care manager role encompassed role strain, a relatively weak professional identity, and differences in professional status among those involved in interprofessional collaboration.

BACKGROUND: According to Swedish law, older adults in Sweden should be able to live a good, safe, and independent life with social and healthcare provided, based on their individual needs. In assisted living in Swedish eldercare the environment affects the older adults' ability to participate in decision-making and strengthens their ability to feel meaningfulness. The ability of staff working in social and healthcare to invite older adults to participate varies. It is important to examine how older adults perceive their situation, as caregivers in eldercare tend to focus on routine work and experience difficulties in meeting the individual needs of older adults. The aim of this study was to explore how older adults in assisted living experienced participation in daily activities.

METHODS: A qualitative interview study was conducted in two municipalities in the western part of Sweden. An exploratory and inductive design was used. Individual interviews were conducted with 11 older adults living in two different assisted living facilities. The data were analysed using thematic analysis.

RESULTS: The interviews resulted in three themes: Being involved, Sense of well-being, and Influenced by the context. The older adults' experiences of participation were interpreted as feelings of being involved in daily life activities, and how they felt involved in their own care and nursing. Participation created prerequisites for well-being. Sense of well-being could be related to feelings of security and social community. The organisation and work environment of the healthcare staff had a great impact on their ability to increase the participation of the older adults. The older adults were aware of the everyday work situation of the providers of social and healthcare and were Influenced by the context.

DISCUSSION/CONCLUSION: Important conditions for a good quality of life and participation for the older adults are to be treated with respect, receive information, and be able to choose. The older adults expressed several good ideas for improvements and a willingness to be involved in the development of the organisation at different levels. It is essential to invite older adults in assisted living to participate in the design of care and nursing.

The understanding of contemporary social problems and challenges in an international and national perspective is a significant issue for social work because of globalisation and social problems are too complex to handle by single actors themselves. The need for interdisciplinary and interprofessional collaboration is important. This paper focuses on experiences from an Erasmus Intensive Programme with the title Human Rights, Public Health and Social Service Challenges on Local Government in the Nordic-Baltic Sea Area. Social work students from different countries interacted with students from other disciplines such as political science, psychology and economy to discuss common challenges and solutions in this field. The analysis of the findings shows students reflect upon human rights issues as universal rights and how challenges presented by contextual differences in preconditions for everyday life between the countries, are reflected from different disciplines/professional perspectives. The paper argues that international and interdisciplinary programmes, where students get the opportunity to meet and to work with overarching and transnational issues, have a great potential for engaging students in global development in a rapidly changing world.

Regionpolitik tycks oftast vara osynlig och regionens politiska organisation ogenomtränglig. Kommunikationsvägarna mellan regionens politiker och tjänstemän och regionens medborgare är otydliga och skapar distans mellan regionpolitiker och medborgare. Då det upplevs som alltför svårt att utkräva ansvar från regionens politiker försvagas medborgares tilltro till den politiska organiseringen. Olika former av medborgardialoger i regionen utgör försök att öka transparensen, skapa tillit och bidra till inflytande för medborgarna. För att lyckas bör syftet med dialogen tydligt kommuniceras både externt och internt, fler grupper bör nås och resultaten bör återkopplas systematiskt.

Aims: To investigate the differences between Sweden, Denmark, Finland and Norway regarding residential/home care units' and frontline managers' background factors, the resources allocated and measures taken during the initial phases of the COVID-19 pandemic, and whether and how these differences were associated with COVID-19 among older people in residential/home units.

Methods: Register- and survey-based data. Responses from managers in municipal and private residential/home units. Number of municipal COVID-19 cases from national registries. Multilevel logistic multivariate regression analysis with presence of COVID-19 among older people in residential/home units as the outcome variable.

Results: The proportions of residential/home units with client COVID-19 cases, mid-March-April 2020 were Denmark 22.7%, Finland 9.0%, Norway 9.7% and Sweden 38.8%, most cases found in clusters. The proportions were similar among employees. Client likelihood of having COVID-19 was six-fold higher if the employees had COVID-19. Mean client cases per residential/home unit were Denmark 0.78, Finland 0.46, Norway 0.22 and Sweden 1.23. For the same municipal infection incidence class, Sweden's mean client infection levels were three-fold those of other countries. The regression analysis variables country, municipal COVID-19 incidence proportion, and care type were associated with client cases at p <= .001. Compared with Denmark, the odds ratios (ORs) for Sweden, Norway and Finland were 1.86, 0.41 and 0.35 respectively. The variable difficulties in preventive testing had an OR of 1.56, p <= .05.

Conclusions: Municipal COVID-19 incidence, employee cases, and the lack of testing resources somewhat explained the confirmed COVID-19 cases among older people in residential/home units. A two- to five-fold unexplained inter-country difference in ORs in the multivariate analyses was notable. The level of protection of vulnerable older clients in municipal and private residential/home units differed between the included countries.

Purpose

The purpose of this paper is to give an account for preparative collaboration between the police and municipal eldercare in Sweden concerning missing persons with dementia.

Design/methodology/approach

Design/methodology/approach used was a qualitative case study design, consisting of one focus group with representatives for the participating organisations, followed by directed content analysis.

Findings

The findings showed a lack of current collaboration and reluctance to new collaborative initiatives. However, when focussing on preparative collaboration of coordinated responses to missing incidents, possibilities for improvement could be identified. The improvements concerned updated personnel response checklists, along with suggestions for an elaborate life story document in eldercare, with police access. Finally, better coordination of the return of the found person and a follow up were proposed.

Research limitations/implications

It is suggested that collaboration must be given different meanings and use different approaches adapted to the different phases in a rescue operation. In the preparation and the response phase, the focus should be on coordination of the resources available. In the pre-planning and prevention phases, as well as in evaluation and learning, horizontal collaboration is more suitable. The amount of data in this study is a research limitation which calls for further research.

Practical implications

It is suggested that collaboration must be given different meanings and use different approaches adapted to the different phases in a rescue operation. In the preparation and the response phase, the focus should be on coordination of the resources available. In the pre-planning and prevention phases, as well as in evaluation and learning, horizontal co-operation is more suitable.

Originality/value

The originality/value of this paper can be found in the novelty of missing person research in Sweden, and in practical suggestions for preparative collaboration concerning persons with dementia who go missing. Finally, it can be found in the suggested need for a more dynamic and process-sensitive view of collaboration in SAR or rescue operations.

Efterforskning av försvunna personer i andra fall (EFP) är den Svenska Polisens räddningstjänstområde. Det är ett område som både tar stora resurser i anspråk och utsätter berörda personer och närstående för ett stort lidande. De stora grupperna som försvinner: personer med demenssjukdomar och personer med suicidproblematik är grupper som ökar i samhället. Därmed är det ett viktigt kunskapsområde.

Syftet med projektet var att göra en internationell kunskapsöversikt över forskning om efterforskning av försvunna personer, identifiera utvecklingsmöjligheter och utmaningar i verksamheten samt ge förslag till fortsatt forskning. Projektet genomfördes som en kvalitativ litteraturstudie där fokus för kartläggningen gällt att analysera och spegla forskningsområdets bredd och mångfald.

Personer kan vara försvunna och/ eller saknas (missing) både ofrivilligt för att de är vilse (lost) eller frivilligt för att de håller sig undan (absent). Personen kan saknas (missing) eller inte saknas av någon. Forskningsperspektiven på området kan främst delas upp i ett s.k. geospatialt perspektiv inriktat mot geografisk positionering och eftersök. Detta perspektiv dominerar synen på verksamheten i Sverige. Det andra perspektivet ”missingness” är inriktat mot upplevelser och processer hos och kring denpersonen som försvinner, anhöriga och samhällsfrågor kring försvinnande.

Stora delar av den internationella forskningen är inriktad på att utveckla och förbättra verksamheten eller ge kunskaper som är viktiga för verksamheten inom exempelvis teknikanvändning, riskbedömning och beteendeprofiler, andel återförsvinnanden, kostnader för insatser, anhörigas motiv för att anmäla försvinnanden och upplevelse av Polisens arbete i insatser.

I Sverige finns ytterst begränsad forskning på området och det finns ett stort kunskapsbehov för att kunna effektivisera såväl efterforskning som förebyggande och uppföljande aktiviteter. Det gäller både rent verksamhetsstöd som digitaliserade databaser för insamling och analys av nationell statistik som idag saknas, liksom metod- och kunskapsstöd samt beslutsstöd. Det finns också ett stort behov att validera internationella forskningsresultat för svenska förhållanden. Förslag till fortsatt forskning och konkreta projekt ges som exempelvis gäller uppföljning och verksamhetsanalys, processbeskrivningar, kostnadsmodeller och kostnadsanalys samt utveckling av effektivitetsmått och nyckeltal, digitalisering och metodstöd, utveckling av samverkan med frivilliga och med andra aktörer, validering av internationella forskningsresultat för användning i Sverige, utbyten och nätverk för praktiker och forskare på området.

Rapporten syftar till att svara mot den övergripande frågan: Hur inverkar arbetsvillkoren för första linjens chefer på chef- och ledarskapet för en god kvalitet inom äldreomsorgen? Det är situationen i Sverige som står i fokus och rapporten sammanställer de huvudsakliga resultaten utifrån ett socialvetenskapligt perspektiv. Med målsättningen att bidra med ackumulativ kunskap tar denna översikt vid där Ann Bergmans (2009) studie ”Att leda inom äldreomsorgen: En litteraturgenomgång av enhetschefers organisatoriska sammanhang och arbetsvillkor” slutar. Bergmans litteraturgenomgång genomfördes på uppdrag av Socialstyrelsen och förhåller sig till litteratur som publicerats fram till och med 2007. Den har till syfte att åskådliggöra några av de faktorer som påverkar arbetsvillkoren för personal inom äldreomsorgen i allmänhet och enhetscheferna i synnerhet. Denna studie bidrar med fördjupad kunskap gentemot Bergmans litteraturgenomgång genom att analysera forskning som bedrivits från och med 2008, men också genom att kunskapen om situationen i Sverige relateras till forskningsresultat om situationen i andra länder.

Forskningsöversikten begränsas till att omfatta Europeiska och Anglosaxiska länder till följd av att likheter och skillnader mellan utvecklingstendenser inom den offentliga sektorn inom dessa geografiska områden redan är väl presenterade i tidigare forskning. Centrala frågeställningar för kunskapsöversikten är: Vad säger tidigare forskning om relationen mellan första linjens chefers arbetsvillkor och god kvalitet inom äldreomsorg? Hur behandlas den socialpolitiska kontexten inom denna tidigare forskning? Vilka skillnader och likheter framträder mellan resultaten i olika socialpolitiska kontexter i denna tidigare forskning?

Första linjens chefer befinner sig i korsdraget mellan politiska ideologier, populär mananagementkultur och en egen professionell kunskap. I uppdraget ingår att balansera krav på effektivitet och kommunikation och i den professionalisering som pågår ställs frågan vilken kompetens chefer behöver för att klara ”mission impossible” utifrån de förutsättningar som ges.

Ny välfärdsteknik och avancerad medicinsk teknik gör det möjligt att bo hemma, även vid ett omfattande behov av kvalificerad omsorg och avancerad vård. Men vad händer när hemtjänsten flyttar in?