PROCOME – Hanna Öfverströms och Marta Roczniewskas grupp

PROCOME fokuserar på forskning om effekter och implementering av innovativa förbättringsprogram i olika typer av organisationer, med särskilt fokus på vård och omsorg. Forskningen syftar till att öka kunskapen om effekter och implementering av olika typer av förbättringsprogram.

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Forskningsbidrag

  • Swedish Research Council for Health Working Life and Welfare
    1 januari 2025 - 31 december 2028
    Research problem and specific questions: The acute staffing crisis in healthcare calls for the need to redesign care delivery models to meet the needs of patients in efficient ways. Remote patient monitoring (RPM) has been proposed as a new model of care to achieve this. Yet, RPM often fails to be implemented due to difficulties in integrating new or changed tasks into the daily work of an already strained workforce. Task shifting has been recommended as a strategy to make best use of available resources, but the shifting of tasks from healthcare staff to patients, caregivers, and digital health technologies remains largely unexplored. Our specific research questions are:How do healthcare professionals, patients, and informal caregivers experience their work tasks related to RPM?How can task shifting and sharing be made explicit in the context of RPM?How does the shifting and sharing of tasks in the context of RPM influence patient, caregiver, and staff experiences?How does the shifting and sharing of tasks in the context of RPM influence healthcare costs?Data and method: The study context will involve four hospitals in the Stockholm Region that are developing RPM services for various care processes. We will engage with the hospitals using an action research approach involving three phases. In phase 1, we will explore experiences of work tasks related to RPM
    in phase 2, we will engage relevant actors in co-designing task shifting strategies
    in phase 3, we will evaluate experiences and costs of task shifting. Data will be collected qualitatively (observations, interviews, focus group discussions, co-design workshops, documents) and quantitatively (questionnaires, care utilization, costs).Societal relevance and utilization: This project addresses the societal challenge of ensuring high-quality healthcare in the face of workforce shortages and increasing patient demands. By exploring how task shifting can be supported in the context of RPM, we aim to provide evidence-based solutions that can improve resource utilization in healthcare, and the experiences of healthcare professionals, patients, and informal caregivers.Plan for project realization: Access to the study setting has been established. Data collection and analysis will be carried out longitudinally by experienced researchers with interdisciplinary expertise, as well as co-researchers from the study context. The costs cover mainly personnel, analysis, and dissemination activities.
  • Swedish Research Council for Health Working Life and Welfare
    1 oktober 2023 - 30 september 2030
    Research problem and specific questions: This program sheds light on the implementation challenges involved in changing health determinants to achieve improvements in public health. The aim of the program is to explore implementation challenges related to decision-making and practical implementation of structural interventions as well as preventive programs and their implication for health equity. The program combines expertise in public health and implementation science with the goal of identifying ways to close the gaps in health among societal groups. Data and method: The program builds on complexity theory to reflect that implementation of public health initiative involves multiple, often interdependent, stakeholders, decisions and activities. The program has three phases. The first is an exploratory qualitative phase including interviews with local politicians and administrators (in municipalities and regions) to understand how they make decisions about public health, including how the needs of different societal groups and conflicting societal goals are prioritized. The second phase involves several naturalistic experiments of local implementation and de-implementation cases investigating barriers and facilitators to these processes, strategies to overcome barriers, management of fidelity and adaptations and implementation outcomes. This entails a participatory approach in which the local actors implement initiatives and participate in collecting data. Analysis includes qualitative and quantitative cross-case comparisons. In the third phase, implementation capacity-building interventions aimed at decision-makers and implementers of public health initiatives are designed and evaluated. Relevance and utilisation: Although Sweden has one of the most developed welfare systems and ambitious public health policy goals, health inequalities are growing and systematic inequalities in health remain in almost all health outcomes and determinants. Implementation of structural interventions and preventive programs are needed, yet implementation research shows that these too often fail to reach, retain and deliver value to those most in need. If implementation between groups diverge, implementation of public health initiatives may increase rather than decrease health inequalities. This program addresses this contradiction by developing new knowledge on how public health initiatives can be implemented for disadvantaged populations. Plan for program realisation: This multidisciplinary program takes a participatory approach involving three research environments at two universities. A total of 63% of the costs cover salaries for the 12 participating junior and senior researchers. Operating costs (15%) include reference group reimbursement, communication activities and data collection.
  • Swedish Research Council for Health Working Life and Welfare
    1 oktober 2023 - 30 september 2029
    Research problem and specific questionsAdults spend a considerable part of their waking hours in the workplace, which means that it is often singled out as an important arena for public health interventions. Nevertheless, the workplace has even greater potential to influence public health: the organization and design of the work itself can contribute to health  – or ill-health. Female dominated municipal administration stands out due to major problems with work-related ill-health which is rooted in problematic working conditions. The purpose of this program is to address ill-health in the female dominated municipal sector by mapping ill-health in occupations and at workplaces and by exploring organizational efforts intending to address its root causes. Data and method and plan for program realisationThe program consists of five projects. The first project uses longitudinal annual register data and quantitative methods to examine the association between female-dominated occupations, female-dominated workplaces, and sickness absence in the municipality sector and how different factors mediate these associations. The second project deals with governance linked to employees and first-line managers in the municipality and the consequences of increased autonomy in connection with trust-based governance. This part will be based on two questionnaire surveys that are designed based on qualitative interviews. The survey data will be analysed using quantitative methods. The third is a collaborative project with municipalities where organizational measures to achieve good health through a better balance between work requirements and resources are created and evaluated using a multi-method approach including both qualitative and quantitative methods. In the fourth project, an experiment examines politicians’ decisions that affect resource allocation in the municipality. This project too has a mixed methods-approach incompassing both qualitative and quantitative methods. Finally, an exploratory project is carried out based on new questions that arise by combining results from the various projects. Relevance and utilisationThe program is closely linked to the national overarching goal for public health, i.e. to create societal conditions for good and equal health in the entire population. The program´s research questions are clearly linked to four of the eight intermediate sub-goals for public health.The unique contribution of the program is that the research question is tackled across several system levels – from the labour market and societal perspective to the decision-making and organizational perspective using an interdisciplinary approach including the disciplines of public health, work life studies, business administration, psychology, sociology and economics. Through the project’s cross-disciplinary approach, the goal is ground-breaking new knowledge with a major impact on both policy and practice.
  • Swedish Research Council for Health Working Life and Welfare
    1 juli 2023 - 30 juni 2027
    Those who takes care of our youngest and oldest for a living tend to have poorer working condition than many others, causing ill health and sickness absence. Previous research has identified several organizational root-causes of work-related ill health, such as understaffing and low decision latitude, calling for solutions on the structural level, that is, in how work is organized, designed and managed. Yet, such organizational occupational health interventions (OOHI) are complex with many factors interacting, making them challenging to evaluate and often yielding inconclusive results. Research-practice collaboration and more sophisticated evaluation methods are needed. This project, co-designed between researchers at Mälardalen university and the municipality of Eskilstuna, aims to explore how a municipality can address root causes of work-related ill-health in female-dominated workplaces. This will be done through a co-creation process to design, implement and evaluate OOHIs in a collaborative, mixed-method, natural longitudinal experiment (around 50 intervention units
    3000 employees). Data collections, including questionnaires and workshops, are integrated in existing organizational processes to both yield new knowledge and support the local change process. Data will be analyzed using an innovative statistical method – coincidence analysis – making it possible to mirror the complex reality where factors may be necessary but not sufficient for reducing sickness absence, or sufficient, but not necessary. In addition, since senior managers are the gatekeepers of OOHIs, we will investigate their beliefs about causes of work-related ill health and if co-creation change those beliefs. This project creates an empirical foundation for a highly needed theory development that can help explain under which conditions implementation of OOHIs succeed or fail as well as provide actionable information for practitioners struggling with implementation.
  • Swedish Research Council for Health Working Life and Welfare
    1 juli 2023 - 30 juni 2030
    Among female dominated workplaces, municipal administration stands out due to major problems with work-related ill-health which is rooted in problematic working conditions. The purpose of this program is to address sickness absence in the female dominated municipal sector by mapping the ill-health in occupations and at workplaces and by exploring organizational efforts intending to address the root causes of this work-related ill-health. The program’s unique contribution is that the research question is tackled across several structural levels – from the labor market and societal perspective to the decision-making and organizational perspective using an interdisciplinary approach including the disciplines of sociology, psychology, economics, business administration and work life studies. The program consists of five projects. The first project uses longitudinal annual register data to examine the association between female-dominated occupations, female-dominated workplaces, and sickness absence in the municipality sector and how different factors mediate these associations. The second project deals with governance linked to employees and first-line managers in the municipality and the consequences of increased autonomy in connection with trust-based governance. This part will be based on two questionnaire surveys that are designed based on qualitative interviews. The third is a collaborative project with municipalities where organizational measures to achieve a better balance between work requirements and resources are created and evaluated using a multi-method approach. In the fourth project, an experiment examines politicians’ decisions that affect resource allocation in the municipality. Finally, an exploratory project is carried out based on new questions that arise by combining results from the various projects. Through the project’s cross-disciplinary approach, the goal is groundbreaking new knowledge with a major impact on both policy and practice.
  • Swedish Research Council for Health Working Life and Welfare
    1 juli 2020 - 30 november 2027
    To ensure the provision of health and welfare services of high quality, safety and cost-effectiveness, managers and professionals are required to implement changes such as new methods and guidelines. Despite this, managers and staff have little training and support in implementation. Lack of implementation capacity is particularly problematic since the new national knowledge-based management structure has the utmost goal that all professionals should use the best knowledge within every encounter with clients and patients. The management structure will provide knowledge-based methods but lacks a plan for how the health and welfare workforces should implement these in practice.The proposed project aims to investigate how implementation capacity can be built within health and welfare organisations by evaluating team training in evidence-based implementation.The Building Implementation Capacity (BIC) intervention builds on the Behaviour Change Wheel and considers implementation as a matter of behaviour change. The intervention will be provided to a total of 90 teams of both managers and staff working in health and welfare organisations. The intervention provides the participating teams with knowledge and skills in applying a systematic implementation model. A longitudinal mixed-methods evaluation will be applied to investigate the extent to which the intervention results in success in practical implementation and the extent to which it develops implementation capacity in the teams and the wider organisation.The uniqueness of this project is that it focuses not only on the implementation of a particular method or guideline, but also evaluates the development and sustainability of implementation capacity in participating organisations. As such, this project aims to contribute to understanding how work teams can build sustainable implementation capacity, and in doing so, contributing to fulfilling the goal of the new national knowledge-based management structure.
  • Swedish Research Council for Health Working Life and Welfare
    1 juli 2020 - 30 juni 2027
    A large number of interventions used in health care lack evidence of effectiveness and may be unnecessary or even cause harm and should therefore be de-implemented. Lists of these types of ineffective (i.e., low-value) practices have become common, but these lists have little chance of leading to improvements without sufficient knowledge regarding how de-implementation can be carried out. Professionals’ decisions regarding de-implementing these practices are not only a matter of scientific evidence
    the puzzle is far more complex with relational, economic and personal interests playing a role.This project aims to investigate how health care professionals navigate the landscape of their individual preferences, conviction of scientific evidence, patient requests and health care system goals to make decisions regarding de-implementation of low-value care.This multidisciplinary project is carried out in four steps, starting with an explorative design to study tensions health care professionals encounter when dealing with low-value practices. Thereafter, a factorial survey experiment will be applied to empirically test how professionals carry out decision-making while considering the tensions. A framework for professionals’ decision-making concerning de-implementation and intervention suggestions will be developed to guide de-implementation of low-value care in health care practice. The project contributes by providing new knowledge on how and why professionals make decisions related to low-value practices. It offers a wider contribution to the research on implementation in terms of closing the gap between research and practice. This project’s novel contribution lies in approaching this gap from the perspective of the care practices used in health care that lack evidence of effectiveness rather than studying how new evidence can be implemented.
  • Swedish Research Council for Health Working Life and Welfare
    1 juli 2020 - 30 maj 2026
  • Swedish Research Council for Health Working Life and Welfare
    1 december 2018 - 30 november 2026
    As the prevalence of chronic illness increases, the demands on healthcare services change. The few hours per year that persons with chronic conditions see healthcare professionals represent a mere fraction of their 24/7 lived experience of coping with their condition. Without patient participation no treatment can be carried out
    thus healthcare services are co-produced. This reality requires a shift from professional-oriented care toward patient-oriented supported self-care. Co-care refers to the decisions and activities shared by patients, their informal caregivers, and professionals, aimed at achieving goals valued by the patient. Consequently, in contrast to involve patients in healthcare, healthcare needs to get involved in people’s self-care, to the extent that the patient needs and desires. Making this shift, however, has been challenging for health care practice.Given this implementation gap, the current program is based on five patient-driven co-care innovations and aims to study how new models of self-care and co-care are best implemented in everyday health care practice and patients’ lives, supported by eHealth. This program is collaboration with patients, their informal caregivers and healthcare providers, to ensure that the research meets patients’ needs. The program is conducted in two phases studying: 1) the implementation of the five patient-driven co-care innovations and the development of patient-valued outcome measures and 2) the impact of the co-care innovations on clinical practice, care organization and patient-valued outcomes, the spread and scaling up of the innovations and production of best practice guidelines. Multiple research designs (e.g. comparative case studies, participatory workshops, adaptive intervention design) will be used. The program generates knowledge that enables people with chronic conditions, their informal caregivers and formal healthcare providers to effectively engage in co-care.

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PROCOME har omfattande nationellt och internationellt samarbete. PROCOME samarbetar också med Enheten för implementering och utvärdering vid Centrum för epidemiologi och samhällsmedicin inom Stockholms läns landsting. Enhetens syfte är att tillhandahålla evidensbaserad information, verktyg och stöd för implementering till regionala verksamhets- och vårdchefer samt medarbetare. Flera av medlemmarna i PROCOME:s forskargrupp arbetar också deltid vid Enheten för implementering och utvärdering.