Diffusion of person-centred care within 27 European countries - interviews with managers, officials, and researchers at the micro, meso, and macro levels.

PURPOSE: This study aimed to describe facilitators and barriers in terms of regulation and financing of healthcare due to the implementation and use of person-centred care (PCC). DESIGN/METHODOLOGY/APPROACH: A qualitative design was adopted, using interviews at three different levels: micro = hospital ward, meso = hospital management, and macro = national board/research. Inclusion criteria were staff working in healthcare as first line managers, hospital managers, and officials/researchers on national healthcare systems, such as Bismarck, Beveridge, and mixed/out-of-pocket models, to obtain a European perspective. FINDINGS: Countries, such as Great Britain and Scandinavia (Beveridge tax-based health systems), were inclined to implement and use person-centred care. The relative freedom of a market (Bismarck/mixed models) did not seem to nurture demand for PCC. In countries with an autocratic culture, that is, a high-power distance, such as Mediterranean countries, PCC was regarded as foreign and not applicable. Another reason for difficulties with PCC was the tendency for corruption to hinder equity and promote inertia in the healthcare system. RESEARCH LIMITATIONS/IMPLICATIONS: The sample of two to three participants divided into the micro, meso, and macro level for each included country was problematic to find due to contacts at national level, a bureaucratic way of working. Some information got caught in the system, and why data collection was inefficient and ran out of time. Therefore, a variation in participants at different levels (micro, meso, and macro) in different countries occurred. In addition, only 27 out of the 49 European countries were included, therefore, conclusions regarding healthcare system are limited. PRACTICAL IMPLICATIONS: Support at the managerial level, together with patient rights supported by European countries' laws, facilitated the diffusion of PCC. ORIGINALITY/VALUE: Fragmented health systems divided by separate policy documents or managerial roadmaps hindered local or regional policies and made it difficult to implement innovation as PCC. Therefore, support at the managerial level, together with patient rights supported by European countries' laws, facilitated the diffusion of PCC.

Is Physiological Equivalent Temperature (PET) a superior screening tool for heat stress risk than Wet-Bulb Globe Temperature (WBGT) index? Eight years of data from the Gothenburg half marathon.

BACKGROUND: The Wet-Bulb Globe Temperature (WBGT) index is a common tool to screen for heat stress for sporting events. However, the index has a number of limitations. Rational indices, such as the physiological equivalent temperature (PET) and Universal Thermal Climate Index (UTCI), are potential alternatives. AIM: To identify the thermal index that best predicts ambulance-required assistances and collapses during a city half marathon. METHODS: Eight years (2010-2017) of meteorological and ambulance transport data, including medical records, from Gothenburg's half-marathon were used to analyse associations between WBGT, PET and UTCI and the rates of ambulance-required assistances and collapses. All associations were evaluated by Monte-Carlo simulations and leave-one-out-cross-validation. RESULTS: The PET index showed the strongest correlation with both the rate of ambulance-required assistances (R2=0.72, p=0.008) and collapses (R2=0.71, p=0.008), followed by the UTCI (R2=0.64, p=0.017; R2=0.64, p=0.017) whereas the WBGT index showed substantially poorer correlations (R2=0.56, p=0.031; R2=0.56, p=0.033). PET stages of stress, match the rates of collapses better that the WBGT flag colour warning. Compared with the PET, the WBGT underestimates heat stress, especially at high radiant heat load. The rate of collapses increases with increasing heat stress; large increase from the day before the race seems to have an impact of the rate of collapses. CONCLUSION: We contend that the PET is a better predictor of collapses during a half marathon than the WBGT. We call for further investigation of PET as a screening tool alongside WBGT.

A national study on collaboration in care planning for patients with complex needs.

INTRODUCTION: The purpose of this study was to investigate inter-organisational collaboration on care planning for patients with complex care needs. Internationally, and in Sweden where the data for this study was collected, difficulties in care planning and transition of patients between the main health care providers, hospitals, municipal care, and primary care are well known. METHOD: A survey of a total population of care managers in hospitals, municipalities, and primary care in Sweden was conducted. The study assessed accessibility, willingness, trustworthiness, and collaboration between health care providers. Data were analysed with descriptive statistics, bivariate, and multivariate regressions. RESULTS: The results indicate that Swedish health care providers show strong self-awareness, but they describe each other's ability to collaborate as weak. Primary care stands out, displaying the highest discrepancy between self-awareness and displayed accessibility, willingness, trustworthiness, and collaboration. CONCLUSION: Inability to collaborate in patient care planning may be due to shortcomings in terms of trust between caregivers in the health care organisation at a national level. Organisations that experience difficulties in collaboration tend to defend themselves with arguments about their own excellence and insufficiency of others.

Economic evaluation of a person-centred care intervention in head and neck oncology: results from a randomized controlled trial.

PURPOSE: Head and neck cancer and its treatment deteriorate quality of life, but symptoms improve with person-centred care. We examined the cost-effectiveness of a person-centred care intervention versus standard medical care. METHODS: In this randomized clinical trial of a person-centred intervention, patients were planned for outpatient oncology treatment in a Swedish university hospital between 2012 and 2014 and were followed during 1 year. Annual healthcare costs were identified from medical records and administrative register data. Productivity costs were calculated from reported sick leave. Health-related quality of life was collected using the EuroQol Group's five-dimension health state questionnaire. RESULTS: Characteristics were similar between 53 patients in the intervention group and 39 control patients. The average total cost was Euro (EUR) 55,544 (95% confidence interval: EUR 48,474-62,614) in the intervention group and EUR 57,443 (EUR 48,607-66,279) among controls, with similar health-related quality of life. CONCLUSIONS: This person-centred intervention did not result in increased costs and dominated the standard medical care. TRIAL REGISTRATION: ClinicalTrials.gov (registration number: NCT02982746).

Assessment of Distress and Quality of Life: A Comparison of Self-Assessments by Outpatients with a Schizopsychotic Illness and the Clinical Judgment of Nurses.

The aim of this study was to investigate how self-assessments of perceived distress and quality of life in patients with schizopsychotic illness are associated with nurse assessments of symptoms, function and life situation. Data were obtained through interviews that used evidence-based rating and visual analogue self-rating scales. Descriptive statistics, correlation and regression analyses were used to process the data. The results demonstrated that the patient self-ratings did not correlate with the nurse assessments, and the perceived distress was not affected by remission status. The findings indicate that patient self-assessments are not a sufficient basis for decisions regarding appropriate treatment interventions.

The association between subcultures and resistance to change--in a Swedish hospital clinic.

PURPOSE: The purpose of this paper is to explore the different subcultures and the employees' preparedness for change at an orthopaedic clinic in a university hospital in Sweden. DESIGN/METHODOLOGY/APPROACH: Surveys were sent out to 179 nurses and physicians. The survey included the two instruments Organisational Values Questionnaire and resistance to change (RTC) Scale. FINDINGS: The results suggest a dominance of a human relations culture, i.e. flexibility, cohesion and trust, in the orthopaedic clinic. These characteristics seemed to decrease RTC. Opposite to this, planning, routines and goal setting appeared to increase change-resistant behaviour. PRACTICAL IMPLICATIONS: By predicting potential obstacles in a certain context prior to a change process, resources can be used in a more optimal way. An instrument that pinpoints the culture of a particular healthcare setting may be a useful tool in order to anticipate the possible outcome of change. ORIGINALITY/VALUE: The rational goal/internal processes dimension exerted a stronger association with RTC than in earlier studies. Deeply rooted standards and routinised care models, governed by work schedules, could be an obstacle to introducing a care model based on the individual needs of the patient. There was, however, a surprisingly low RTC. The results are contrary to the accepted understanding of public organisations known to be slow to change.

Culture as a predictor of resistance to change: a study of competing values in a psychiatric nursing context.

It is well known that a conservative organizational culture can hinder the implementation of new organizational models. Prior to introducing something new it is important to identify the culture within the organization. This paper sets out to detect the feasibility of reform in a psychiatric clinic in a Swedish hospital prior to implementation of a new working method - a structured tool based on the International Classification of Functioning Disability and Health. A survey consisting of two instruments - an organizational values questionnaire (OVQ) and a resistance to change scale (RTC) - was distributed to registered and assistant nurses at the clinic. The association between the organizational subcultures and resistance to change was investigated with regression analysis. The results revealed that the dominating cultures in the outpatient centers and hospital wards were characterized by human relation properties such as flexibility, cohesion, belongingness, and trust. The mean resistance to change was low, but the subscale of cognitive rigidity was dominant, reflecting a tendency to avoid alternative ideas and perspectives. An instrument like the one employed in the study could be a useful tool for diagnosing the likelihood of extensive and costly interventions.

Daily life dialogue assessment in psychiatric care-face validity and inter-rater reliability of a tool based on the International Classification of Functioning, Disability and Health.

This article describes the development of an assessment tool based on the International Classification of Functioning Disability and Health (ICF) adapted to a psychiatric nursing context where both the patient and the nurse assess the patient's ability to participate in various spheres of life. The aim was to test psychometric properties, focusing on face validity and inter-rater reliability. Three Swedish expert groups participated. Analysis of inter-rater reliability was conducted through simulated patient cases. The results of an unweighted kappa value of 0.38, a linear weighted kappa value of 0.65 and a quadratic weighted kappa value of 0.73 were considered as acceptable when using simulated patient cases.

During and beyond the triage encounter: chronically ill elderly patients' experiences throughout their emergency department attendances.

BACKGROUND: Chronically ill elderly patients are frequent users of care in emergency departments (EDs). Due to their presenting symptoms, these patients are often assessed on a low urgency level of priority by the triage nurse. AIM: The aim of the study was to explore and describe the experiences of a group of chronically ill elderly patients' during their triage encounter and subsequent ED stay. METHOD: The data consisted of 14 open-ended interviews with chronically ill patients aged between 71 and 90years. A lifeworld approach was used in order to describe the essence of patient experiences. The study was carried out with a descriptive phenomenological research perspective. CONCLUSION: The visit to the ED was experienced as contradictory. The triage encounter fostered confidence and set promising expectations, but during the rest of the visit, the patient felt abandoned and considered the staff to be uncommitted and reluctant. These ambiguous experiences of their ED visits indicate a need for exploring possible ways of improving the situation for the chronically ill older person in ED.

Organizational culture and the implementation of person centered care: results from a change process in Swedish hospital care.

Sweden has one of the oldest, most coherent and stable healthcare systems in the world. The culture has been described as conservative, mechanistic and increasingly standardized. In order to provide a care adjusted to the patient, person centered care (PCC) has been developed and implemented into some parts of the health care industry. The model has proven to decrease patient uncertainty. However, the impact of PCC has been limited in some clinics and hospital wards. An assumption is that organizational culture has an impact on desired outcomes of PCC, such as patient uncertainty. Therefore, in this study we identify the impact of organizational culture on patient uncertainty in five hospital wards during the implementation of PCC. Data from 220 hospitalized patients who completed the uncertainty cardiovascular population scale (UCPS) and 117 nurses who completed the organizational values questionnaire (OVQ) were investigated with regression analysis. The results seemed to indicate that in hospitals where the culture promotes stability, control and goal setting, patient uncertainty is reduced. In contrast to previous studies suggesting that a culture of flexibility, cohesion and trust is positive, a culture of stability can better sustain a desired outcome of reform or implementation of new care models such as person centered care. It is essential for health managers to be aware of what characterizes their organizational culture before attempting to implement any sort of new healthcare model. The organizational values questionnaire has the potential to be used as a tool to aid health managers in reaching that understanding.