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Biomedical subjects

Mats Brommels

Publications and source records attributed to Mats Brommels.

11 recordsLinked to original sources
PubMed2006

Determinants of health promotion action: comparative analysis of local voluntary associations in four municipalities in Finland.

The World Health Organization makes a case for the importance of voluntary organizations in promoting health at local levels. The purpose of this paper is to contribute to understanding which factors explain local voluntary associations (LVAs) participation in health promotion in local contexts. It does so through (i) identifying indicators that represent determinants of health promotion action which were reported by LVAs and by (ii) comparing their actions with these determinants. The data reported are from a questionnaire survey of all registered LVAs in four municipalities in Finland. Principal component analysis revealed four determinants of health promotion action. Four factors in the final multivariate model explained over half of the variance of LVAs engagement in health promotion action: competence, values 'healthy' and also opportunities and municipality. There is some evidence to support a model of health promotion action which has not been tested empirically in relation to these types of organization. More detailed studies of determinants of health promotion action are needed to shape strategies in local communities.

Community Health Planning↗
PubMed2006

Client perceptions of the performance of public and independent not-for-profit primary healthcare.

AIMS: To compare primary healthcare (PHC) provided by an independent not-for-profit organization (INPO) with that provided by two public municipal organizations (MO1 and MO2), in terms of clients' perceptions of performance, acceptance, and trust. METHODS: A survey using a pre-tested questionnaire to all clients visiting a health centre (HC) doctor or nurse during one week in 2000 (n = 511, 51% response rate) and 2002 (n = 275, 47%). The data were analysed by descriptive statistics and cumulative logistic regression analysis. RESULTS: The INPO differed from both publicly provided services in accessibility, consistency of service, and outcomes. Clients reported lower trust in HC provided by public organizations compared with the INPO. Trust was higher if clients also reported experiencing "very good" or "moderate" organizational access--or if general satisfaction was "very high" or "moderate" or if they experienced outcomes as "very good" or "moderate" compared with the "very poor or low" situation. Women reported lower trust in HC than men. When the family doctor was included in the same logistic regression model with the service provider, only the family doctor was a significant explanatory variable. Reported acceptance of private alternative service providers among clients was similar between the study organizations. CONCLUSIONS: Clients of the INPO generally rated the service more positively than clients of publicly provided services. The results indicate that trust in HC depends more on a family doctor system than a service provider.

Adult↗
PubMed2004

Case-mix adjustment and efficiency measurement.

AIMS: The importance of using valid case-mix systems in long-term care is addressed by comparing the predictive power of different case-mix models, and by applying them in the calculation of technical efficiency scores of care units. METHODS: To construct different case-mix models a statistical clustering technique (Automatic Interaction Detection) was used. Technical efficiency score were calculated using data envelopment analysis (DEA). RESULTS: The Resource Utilization Groups (RUG-III/22) classification explained 39% of resident specific cost, compared with 16% for a functional dependency scale in the Finnish patient information system HILMO. CONCLUSION: When assessing the economic performance of long-term care units it is important to pay attention to the predictive validity of the case-mix measure to be used. The choice of case-mix measure significantly affected how units were rated in efficiency.

Activities of Daily Living↗
PubMedDate not supplied

Do women simply complain more? National patient injury claims data show gender and age differences.

The Swedish Counties Mutual Insurance (LOF) owns and operates the Swedish Patient Insurance Company, (PSR) a no-blame insurance system that compensates patients for injuries that result from errors in medical practice. We combined malpractice claims data (from PSR) with national hospital discharge registry data (National Board of Health and Welfare-Socialstyrelsen) and determined Swedish inpatient malpractice claims rates for the years 1996-2000. Women have higher claims rates than men, but their claims are adjudicated as valid more often than men's claims. The data are consistent with other lines of evidence suggesting poorer quality of care for women, e.g., heart disease, kidney disease, and cancer. Middle-aged (40- to 59-year-old) patients file malpractice claims at almost twice the national rate, whereas patients younger than 19 years and older than 80 years of age file at significantly below the average rate. Differences in claims rates have major financial and quality of care implications. Further studies are needed.

Adolescent↗
PubMedDate not supplied

Is health care a special challenge to quality management? Insights from the Danderyd Hospital case.

A 10-year quality journey of a Swedish university hospital is described in this case study based on a variety of data sources. A series of quality initiatives were implemented according to total quality management (TQM) "best practice." Many projects were successful, but still a majority of those did not meet the staff's requirement of practical relevance, and they provoked scepticism toward instruments introduced and resistance to service-related quality definitions. The hospital's incentive structures did not reward an engagement in improvement activities. The findings are interpreted as demonstrating that the programs were viewed upon as part of a "management" rather than "professional" agenda, despite the underlying philosophy of TQM. It is suggested that applying professional practice development approaches to improvement initiatives might help to overcome the barrier thus created.

Attitude of Health Personnel↗
PubMedDate not supplied

Guidelines for appraisal and publication of PDSA quality improvement.

Plan-do-study-act (PDSA) quality improvement is the application of the scientific method to implement and test the effects of change ideas on the performance of the health care system. Users of quality improvement could benefit with markers to gauge the "best" science. Four core questions can determine the value of a quality improvement study: Is the quality improvement study pertinent and relevant? Are the results valid? Are appropriate criteria used to interpret the results? Will the study help you with your practice or organization of care? A set of guidelines is provided to help answer these questions. Similar guidelines exist for randomized clinical trials and clinical-epidemiologic observational studies. Analogous to these existing research guidelines, the PDSA quality improvement guidelines will provide researchers and reviewers with succinct standards of methodological rigor to assist in critical appraisal of quality improvement protocols and publications.

Guidelines as Topic↗
PubMedDate not supplied

Learning helpers: how they facilitated improvement and improved facilitation--lessons from a hospital-wide quality improvement initiative.

Quality improvement is a leading approach to the difficult yet inevitable task of managing organizational change. The literature suggests that facilitators can help organizations apply improvement principles and tools but it is unclear how facilitators actually do this and how they develop their own skills. Using a case study design we therefore examined how facilitators worked with 93 improvement projects in over 1000 sessions at one Swedish university hospital where systematic process improvement was successfully established over a 5-year period. They facilitated improvement by providing a framework and methods' support for improvement efforts--relying on experiential learning rather than didactic teaching--while letting clinical teams and managers maintain control over the content of improvement projects. They developed extensive experience that they documented and could transfer between teams, so that each team could benefit from lessons learned elsewhere. They improved facilitation through participant feedback and systematic review and reflection regarding their own practice. We suggest that facilitators can help organizations manage change by assuming responsibility for demanding tasks related to improvement work, developing specialized skill and extensive experience regarding improvement, and transferring insights across the organization, while using a learning approach throughout including to their own work.

Hospitals, University↗
PubMedDate not supplied

Getting going together: can clinical teams and managers collaborate to identify problems and initiate improvement?

A clear aim is key for the success of improvement projects, yet many fail already at this stage. We studied how clinical teams and managers at a university hospital in Sweden identified problems and defined aims as they initiated 24 process improvement projects. Categorizing and comparing problems at 3 stages of problem definition, we found that the majority of problems fell into 1 of 3 categories: information issues, poor procedures, and waiting times. Going through these stages, managers and clinical teams prioritized waiting-time problems. We show how managers can ask such teams to quickly identify problems suited for improvement projects through this step-wise, facts-based approach. We conclude that they can add their management perspective when giving specific assignments, to harness the combined benefits of both a bottom-up and a top-down approach to improvement.

Cooperative Behavior↗