The implementation of evidence-based methods in hospital settings is difficult and complex. The aim of the present study was to highlight the implementation process concerning a new working method, i.e. a new assessment tool, based on the International Classification of Functioning Disability and Health (ICF), among psychiatric nursing staff on five participating wards at a Swedish county hospital. Descriptive, qualitative data were collected through focus group interviews pre- and post-implementation. Data were analysed using directed content analysis, guided by Normalization Process Theory (NPT). The results revealed that just one of the five participating wards met the criteria for a successful implementation process. The results confirm previous studies showing the difficulty of implementation. Although participants agreed with the intention of the model, they were reluctant to apply it in practice. The implementation process seemed to be influenced by factors such as: time pressure; heavy workload; stress; lack of routines in using the tool; lack of nursing staff; as well as cultural characteristics and resistance to change.

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

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

Findings 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.

Originality/value 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.

Purpose - The purpose of this article was to identify and study common incentives for teamwork.

Design/methodology/approach - The study was designed as a case study. The case consists of teamwork at a univer-sity hospital. At the hospital, ten psychiatric teams were studied for a period of four years (2008-2011). Each team was followed for 12–18 months. Data were collected through interviews (n = 48) and observations (n = 52) of the teamwork at treatment conferences.

Findings - The common incentives identified consist of shared responsibility, appreciation and long-sightedness. The incidence of a silent contract is highlighted as an explanation for the team's cohesion.

Research limitations/implications - The study is conducted in a public organisation within one field. The results should therefore be interpreted with some caution.

Practical implications - The study is useful for practitioners to understand the importance of common incentives as a collective driving force. By developing well-adapted common incentives, the practical work can be developed, refined and improved.

Originality/value - The significance of common incentives and the unspoken contract in the team is identified.

Purpose: The purpose of this paper was to study how psychiatric doctors practise leadership in multidisciplinary healthcare teams. The paper seeks to answer the question: How do psychiatric doctors lead multidisciplinary teams during treatment conferences?

Design/methodology/approach: Six psychiatric teams were studied at a university hospital. Each team was observed over a period of 18 months, and data were collected during four years (2008-2011). Data were collected through interviews with doctors (n19) and observations (n30) of doctors’ work in multidisciplinary psychiatric teams.

Findings: Doctors in a multidisciplinary team use either self-imposed or involuntary leadership style. Oscillating between these two extremes was a strategy for handling the internal tensions of the team.

Research limitations/implications: The study was a case study, performed during treatment conferences at psychiatric wards in a university hospital. This limitation means that there is cause for some caution in generalising the results.

Practical implications: The results are useful for understanding leadership in multidisciplinary medical teams. By understanding the reversible logic of leadership, cooperation and knowledge sharing can be gained, which means that a situation of mere peaceful coexistence can be avoided. Understanding the importance of the informal contract makes it possible to switch leadership among team members. A reversible leadership with an informal contract makes the team less vulnerable. The team’s professionals can thus easily handle dif cult situations and internal tensions, facilitating leadership and management of multidisciplinary teams.

Originality/value: Doctors in multidisciplinary psychiatric teams use reversible leadership

logic.

Purpose: The overall purpose of the article was to study how doctors practise leadership in multidisciplinary teams. The article seeks to answer the question: Which approach do doctors use to lead multidisciplinary psychiatric teams?

Methodology: Six psychiatric teams were studied at a university hospital. Each team was followed for eighteen months. Data were collected during a period of four years (2008–2011). Data were collected through interviews with doctors (n = 19) and observations (n = 30) of doctors’ work in a multidisciplinary psychiatric team.

Findings: Doctors in a multidisciplinary team use either self-imposed or involuntary leadership. Oscillating between these two extremes is called reversible leadership.

Research limitations: The study was performed at a psychiatric ward during treatment conferences in a university hospital. This limitation means that there is cause for some caution in interpreting the results.

Practical implications: The results are useful for understanding leadership in multidisciplinary teams within the health and medical care system. The reversible leadership means that doctors can more easily oscillate from difficult situations and deal with internal tensions, facilitating leadership and management of the multidisciplinary team in the intended direction.

Originality / value: Doctors in multidisciplinary psychiatric teams use reversible leadership.

This study is about leadership and decision-making in psychiatric teams. To manage healthcare, cross-organisational work has been used as a working method in teamwork.

The overall aim of the study was to study how leadership and decision-making are applied in psychiatric teams. The issues addressed are: to describe and to understand how leadership in psychiatric teams is applied, to describe and to understand how decision-making in psychiatric teams is applied, explain why there are potential differences between talk and practice, and to explain why teamwork is applied in psychiatry.

The study's theoretical framework is based on the challenges that arise when teamwork is organised in a multi-professional context. In the study, decision theory, leadership theory and new institutional theory are used to help to link together and provide explanations for behaviour patterns of professions.

The study's data were collected between 2008–2011 through interviews, observations and document studies. Total study consists of 101 interviews with 111 informants. Observations have been done of 10 teams on 132 occasions for a total of 230 hours. Observations have focused on the teamwork carried out in the treatment conferences.

The study shows that: 1) there is an informal contract in teams that governs who does what in different situations, 2) doctors applied a reversible leadership where they alternated between the involuntary and the self-imposed, 3) teams used decision norms that are governed by situation-specific micro-codes, 4) there is an episodic culture which decreased the incentive to provide preventive and long-term treatment, 5) teamwork was used to provide the opportunity for solidarity, classification and control, and 6) there was no striving for perfection in decision-making; instead, the teams were satisfied with an acceptable level that everyone could agree on.

SammanfattningSyfte: Syftet med artikeln är att beskriva och problematisera läkares ledarskap i team. Arti-keln syftar till att besvara frågan; Hur utövar läkare ledarskap i team?Design/metod: Studien är designad i form av en fallstudie. Sex psykiatriska team har stude-rats vid ett universitetssjukhus. Varje team har följts under 18 månader. Datainsamlingen har gjorts under totalt fyra år (2008-2011). Data har samlats in genom intervjuer med läkare (n=19) och observationer (n=60) av läkares arbete i team.Resultat: Läkares ledarskap i team utövas i en dualistisk pendlingsprocess mellan självpåta-get och ofrivilligt, vilket benämns reversibelt ledarskap.Begränsningar: Studien är gjord på psykiatriska avdelningar i en organisation. Det finns därför anledning till viss försiktighet vid tolkningen av resultaten.Praktiska implikationer: Resultaten är användbara för att förstå teamledarskapets dualism. Reversibelt ledarskap kan leda till ökad osäkerhet och försvaga teamets proaktiva förmåga.Originalitet: Läkarens ledarskap i team lyfts fram som reversibelt, antingen självpåtaget och frivilligt, eller påtvingat och ofrivilligt.Nyckelord:

Abstract Rationale, aims and objectives  In this article, ideal conceptions about teamwork are tested. The research question posed is: How are teams in psychiatry formed? Three theoretical concepts that distinguish groups from teams are presented: sequentiality, parallelism and synchronicity. The presumption is that groups cooperate sequentially and teams synchronously, while the parallel work mode is a transitional form between group and team. Methods  Three psychiatric outpatient teams at a university hospital specialist clinic were studied. Data were collected through 25 personal interviews and 82 hours of observations. The data collection was carried out over 18 months (2008–2009). Results  Results show: (1) that the three theoretical distinctions between group and team need to be supplemented with two intermediate forms, semiparallel and semisynchronous teamwork; and (2) that teamwork is not characterized by striving towards a synchronous ideal but instead is marked by an adaptive interaction between sequential, parallel and synchronous working modes. Conclusions  The article points to a new intermediate stage between group and team. This intermediate stage is called semiparallel teamwork. The study shows that practical teamwork is not characterized by a synchronous ideal, but rather is about how to adaptively find acceptable solutions to a series of practical problems. The study emphasizes the importance of the team varying between different working modes, so-called semisystematics.

The purpose of this paper is to study what professional emergency personnel learn during collaboration exercises and the benefits of what they have learned. Observations (n=19) and semistructured interviews (n=32) were carried out in conjunction with major exercises held in Sweden (2007–2012). The results show that exercises tend to be based on its own logic, which differs from actual events. Exercise participants believe that they mainly learn single-track, parallel and path-dependent behavior. The exercises do not facilitate the use of cross-boundary activities. This means that learning as well as benefits of the exercises for actual events is limited. The exercises would be more appropriate if those participating had the opportunity to identify weaknesses, try alternative ways as well as had the opportunity to have comprehensive organizational analyses at the conclusion of the exercises. Based on the results of the study, alternative models for the exercises are suggested that contain elements, which develop collaboration and contribute to learning.

This study identifies hidden artefacts in a public organisation. In contrast to earlier studies, itfocuses on artefacts as concealing rather than conveying meaning. Negligent behaviour causedby an unpopular culture was recognised in five psychiatric wards at a Swedish universityhospital. Data comprising observations (87 h) and interviews (n = 60) were collected over aperiod of 48months (2008–2011). Four different items used in everyday work representing adeeper meaning of the organisation were identified during the observations. The items selectedwere work attire, nametags, keys and restraint beds. These were considered particularly promisingwhen it came to the aim of the study, namely, to find out how artefacts are camouflaged. Theobservations and the interviews revealed that these were controversial and contested artefacts inthe organisation. The study uses the term ‘cultural camouflage’ for behaviour that ignores andconsciously conceals symbols that have negative values. This concept contrasts with previousresearch that shows how artefacts are emphasised and how they contribute to the character ofthe activity in a transparent way. Conservative and backward-looking behaviour among staffprovided one explanation as to why artefacts were concealed. Another was the need to establishharmonious internal interactions.

Samverkan mellan olika yrkesprofessioner på en olycksplats är komplicerat. Mycket på grund av att förväntningarna inte alltid överensstämmer med förutsättningarna. I boken problematiseras agerandet på olycksplatsen. Friktionen mellan yrkesprofessioner lyfts fram och olika beteendemönster diskuteras.I boken tar författarna samverkan från retorik till ett praktiskt redskap, något som är möjligt att konkretisera och utföra praktiskt i det dagliga arbetet. Boken utgör samtidigt en introduktion till övningstekniken 3-nivåsamverkan (3-NS).I den här boken bjuds på flera närgångna beskrivningar. Medarbetare från fältet berättar om sina erfarenheter av samverkan, hur den tillämpas, om vilka möjligheter som finns och vilka svårigheter som behöver hanteras.Boken riktar sig till alla som arbetar i eller i anslutning till blåljusorganisationer. Den kan med fördel användas som lärobok för universitets- och högskolestuderande som läser till yrken inom polis, räddningstjänst eller ambulanssjukvård. Boken passar också för vidareutbildning av redan yrkesverksamma. Den kan även med fördel läsas av forskare, tjänstemän och politiker med intresse för hur framtidens blåljusorganisationer ska ledas, organiseras och styras.

This study relates to collaboration exercises, with particular focus on the full-scale exercises between the police, rescue services and ambulance. To succeed in a complex situation, it requires that the personnel’s ability to collaborate across organisations be developed and refined.

The overall aim of this study was to examine how collaboration is practised and how exercises lead to learning and usefulness. A research summary was initially done in this study. Based on that, a number of key concepts were developed that proved helpful when we followed the Swedish collaboration exercises through interviews and observations. The collected analysis has since been the basis for the design of a new exercise model, 3LC, three-level collaboration. It is based on the experiences we have had in studies of traditional exercises.

The 3LC exercises that were conducted consisted of two practical sessions and three seminars. Each session was followed by an evaluative seminar with the aim that participants themselves would reflect and develop their patterns of behaviour. The two practical sessions were identical. It gave the participants the opportunity to rehearse and methodically try new approaches. The first exercise session was carried out according to the procedures that normally apply and govern the actions at an actual event. The second exercise session was preceded by a self-critical seminar where participants themselves identified what could be improved for the next exercise session.

The research project was carried out from 2011 to 2014. A total of 19 collaboration exercises were studied, including 16 full-scale exercises. A total of 97 interviews and 125 hours of observation were carried out in this study. A questionnaire (CLU instrument) was developed, which was answered by 272 exercise participants.

The study shows that collaborative sessions in the exercises contributed to the participants learning more and having greater usefulness from the exercises. 3LC exercises were perceived to enhance learning by 26 per cent and usefulness by 17 per cent, compared with traditional exercises. Collaborative exercises are benefitted when participants analyse their weaknesses themselves. Repetitive elements where participants try out alternative strategies improve preparedness prior to actual events.

In this paper, the focus is on emergency exercises between the police, rescue services and ambulance. By practising, it is assumed that the conditions improve for a quick normalisation after an incident. The purpose of this paper is to identify whether the exercises are designed after organic action logic and therefore can be assumed to strengthen the ability to handle emergencies. Data have been collected at two large, regional, full-scale exercises (2008 and 2012). Data collection has been done through observations and document studies. The study shows that mechanistic behaviour is quite prevalent in the two studied exercises. They are time consuming and put little emphasis on practising organic behaviour. Too complex exercise scenarios contribute to a low tempo, long waiting periods and slow implementation. To succeed, the exercises need to have a non-linear time sequence and limited scenarios that invite participants to focus on organisational interfaces.

This article reviews the traditions of the health care industry while challenged by trends. Strong professions, ambiguous and contradictory aims, and a lack of resources have contributed to difficulties managing contradictory needs. One way to handle the situation is to introduce systems based on freedom of choice, inter organisational and professional work, and an improved degree of flexibility. The trends are mainly influenced by New Public Management control models. The mixture of new and traditional types of management control has produced organisational hybrids. These organisational hybrids have contributed to organisational tensions from the old as well as the new in an inconsistent but regenerating way.

The aim of the study was to examine the emergency personnel’s perception of the effects of exercises, with regard to learning and usefulness. The exercises were quasi-experimental and constructed in such a way that employees from different organizations overlapped each other’s tasks. This was accomplished by: having asymmetries included in the scenarios, repeating exercise procedures and testing different strategies, which were discussed at joint seminars. The exercises were compared to a similar study, published in this journal, of nonquasi-experimental but merely traditional exercises. Surveys were distributed and collected from emergency personnel in connection with seven exercises. At the exercises, 94.3% of the personnel thought that the exercises had a focus on collaboration (traditional exercises, 75.6%).

I den här boken får du möjlighet att bekanta dig med de styrmodeller som har tillämpats inom vården under de senaste decennierna. Författarna ger en bild av vad de olika modellerna tenderar att leda till på kort respektive lång sikt. Trender, regler, resultat, arbetsfördelning och de speciella förutsättningar som gäller för styrning i professionella organisationer behandlas.Boken riktar sig till utbildningar inom hälso- och sjukvårdsadministration, vårdvetenskap, socialt arbete, arbetsvetenskap, offentlig förvaltning, företagsekonomi och service management samt till praktiskt yrkesverksamma. Den kan även med fördel läsas av forskare, tjänstemän och politiker med intresse för hur framtidens hälso- och sjukvård ska organiseras och styras.

Hälso- och sjukvården står i dag inför en rad ekonomiska, demografiska och medicinska utmaningar. Hur den ska styras och organiseras blir därför en angelägen fråga. Den här boken, som nu kommer i sin andra upplaga, beskriver några av de styrmodeller som har tillämpats inom vården under de senaste decennierna. Hit hör exempelvis beställarstyrning, kundvalsmodellen, balanserad styrning, teamarbete, prestationsfinansering och processorientering. Författarna lyfter fram fördelar och nackdelar med de olika modellerna och visar vad de tenderar att leda till på kort respektive lång sikt. 

Team är populära, inte minst inom vård, behandling och omsorg.Trots att det börjar bli en väl etablerad företeelse tycks teamfortfarande stå för förnyelse och nytänkande. Teamarbete harsåledes kommit att få en allt viktigare roll.

I denna antologi behandlas frågor som: Varför uppstår team? Vadgör team nödvändiga? Vad är utmärkande för olika typer av team? Vad skapar väl fungerande team? Vilka effekter får teamarbete förverksamheten? Du som läsare bjuds på både kritiska betraktelser,utvecklingsspår och verktyg.

Boken vänder sig till studerande och forskare vid högskolor ochuniversitet samt till praktiskt verksamma inom vård-, behandlingsochomsorgsorganisationer. De olika kapitlen kan läsas friståendeoch ger var för sig en god bild av teamets funktion.

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Team i vård, behandling och omsorg förmedlar en unikinsikt och förståelse kring teamarbetes betydelse, funktionssätt och utmaningar baserad på omfattande och mångårig forskning. Boken förtjänar därför attanvändas inom alla utbildningar på högskolenivå som är inriktade mot vård- och omsorg.

Stefan Tengblad, professor i företagsekonomi

The aim of this study was to describe nurses’ experiences of person-centered care within an integrated care chain.

Method: The study included four data sets: Two focus group interviews with a total of 22 nurses; an open questionnaire answered by 17 nurses; and individual follow-up interviews with 4 volunteers from among the 17 nurses. In total, 39 informants were included in this study. Qualitative content analysis was carried out to identify the latent content of the focus group and interview data, and the manifest content of the questionnaire data.

Results: The results showed that learning about, from and with each other were prerequisites for achieving person-centered care. The ability to provide person-centered care was influenced by factors that could be related to both the organization and to the individual nurse. Important factors were organizational transparency and structure, leadership and collaboration between healthcare centers, partnership, sole caregiver attitudes and skills.

Conclusion: In order to develop person-centered care, it is crucial that an integrated care chain feature a joint documentation system; efficient use of the resources allocated to the needs of the various healthcare centers; and a change of focus from the professional to the person seeking care.

This study aimed to elucidate exercise participants’ understanding of critical aspects of organizing and implementation of collaboration exercises with police, fire department and ambulance services. The focus is critical aspects in exercises that have, or are expected to have, bearing on the participants’ ability to learn. Collaboration exercises are used as a tool to reinforce and develop the preparedness for future incidents. The need for such exercises was usually advocated after critique to actions during largescale real-life incidents. The study had a qualitative approach and is based on phenomenographic analysis of interviews with participants from four exercises with different scenarios. The identified critical aspects of exercises were related to realism, acceptance for mistakes, exercise extent and aims and opportunities for joint discussions. The management of an accident can be described to a large extent depend on the organizations’ joint ability to adapt to the prevailing situation and to collaborate. For exercises to contribute to these abilities, they could benefit from shifting the focus to how to organize exercises that allow participants to test different decisions and actions, with less emphasis on the choice of scenario.

Aim: This study seeks to build upon a prior investigation into the impact of the COVID-19 pandemic and to evaluate the prevalence of anxiety among Brazilian children, along with its associated factors, one year after the commencement of the pandemic.

Design: A cross-sectional study.

Methods: A survey was conducted from April–May 2021 in Brazil. Children aged 6–12 and their guardians from five Brazilian regions were included. The Children’s Anxiety Questionnaire (CAQ; scores 4–12) and Numerical Rating Scale (NRS; scores 0–10) were used to measure anxiety.

Results: Of the 906 children, 53.3% were girls (average age = 8.79 ± 2.05 years). Mothers responded for 87.1% of the children, and 70.9% were from the Southeast region. Based on a CAQ score of ≥9 and an NRS score of ≥8, the anxiety prevalence was 24.9 and 34.9%, respectively. Using logistic regression, a CAQ ≥9 score was associated with older children and children with chronic disease or disability. An NRS score of ≥8 was associated with reduced family income during the pandemic, the person caring for the children, and with children with chronic disease or disability.

Conclusion: These findings suggest the need to implement public health actions aimed at children with chronic diseases and disabilities and their parents to guide them regarding the warning signs and negative emotions. This study contributes to characterizing the evolution of the pandemic in Brazil and provides a basis for comparison with the literature from other countries.

This dissertation will explore the intersection of digitalization and innovation focusing on the management of workplace learning. Adopting a sociocultural perspective, it concentrates on the organizational level, specifically on how management supports workplace learning within municipal healthcare services. The research in the dissertation is delimited to a Nordic healthcare sector, focusing on healthcare within municipal homecare and nursing homes in Sweden and Norway. In many countries, digitalization and innovation are increasingly seen as vital tools for tackling societal challenges and promoting sustainability, particularly concerning the growing gap between available resources and the increasing need for healthcare services. Despite the widespread belief in digitalization and innovation as solutions, and a generally techno-utopian or techno-optimistic outlook on digital technologies, the digital transformation of the healthcare sector has proven to be complex and has not always yielded the anticipated positive results. Factors such as experience, skills, training, knowledge, expectations regarding technology and its use, habits, and the learning environment at the workplace can all impact both the utilization of technology and the potential for driving innovation. This dissertation is built upon two studies, utilizing a qualitative research approach rooted in Engaged Scholarship. In the first study, several rounds of focus group interviews are conducted with managers and employees in municipalities in Sweden and Norway, focusing on current use, needs, and future potential for technology and digitalization, as well as mapping, analyzing, and further needs for development, organization, decisions, and guidelines to then sharpen the focus on learning and knowledge. Study II was organized as a case study following an innovation pilot project in healthcare within a Swedish municipality. Individual and group interviews were conducted with managers and employees, and viii participatory observation took place during workshops throughout the process of the pilot. The results and analyses from the two studies are detailed in the five appended articles. The findings of this dissertation highlight a gap between the current workforce’s competencies and the skills necessary for effectively implementing and utilizing new technologies. It suggests that organizing for workplace learning requires organized learning, with a particular emphasis on active and engaged management. A three-part strategy for organized learning is proposed, which includes: i) individualization through learner-centeredness, ii) the management’s use of tools and strategies, and iii) fostering a participatory learning environment. This dissertation enhances the understanding of organizing for learning in the context of digitalization and innovation within municipal healthcare services, focusing on both individual and organizational perspectives, and particularly the role of management

Digitalization and technology are interventions seen as a solution to the increasing demand for healthcare services, but the associated changes of the services are characterized by multiple challenges. A work-integrated learning approach implies that the learning outcome is related to the learning environment and the learning affordances available at the actual workplace. To shape workplace affordances it is of great importance to get a deeper understanding of the social practices. This paper will explore a wide range of managers' and professionals' emotions, moods and feelings related to digitalization and new ways of providing healthcare services, as well as the professionals' knowledge and experiences. Zhang's affective response model (ARM) will be used as a systematic approach and framework to gain knowledge of how professionals and managers experience and experience digitization of municipal health services. The research question is: How can knowledge about dark sides of technology reduce barriers to work-integrated learning?This paper is based on a longitudinal study with a qualitative approach. Focus group discussions were used as method for collecting data. The findings and themes crystallized through the content analysis were then applied to the Affective Response Model as a systematic approach to gain more knowledge about professionals and managers' experiences and how that knowledge can reduce the barriers to work-integrated learning. Understanding of, and consciousness about the dark sides of technology and the professionals' affective responses may support the digitalization of the sector and the development of the new ways of providing healthcare services.

BACKGROUND: Although coordination of care and integrated care models aim to enhance patient satisfaction and perceived care quality, evidence regarding their practical implementation remains scarce. Understanding the nuances of collaboration across care providers to achieve effective coordination of care is imperative for seamless care integration. The aim of this study was to construct a grounded theory of how inter-organizational collaboration is performed to support coordination of care for patients with complex care needs.

METHODS: A qualitative design with a constructivist grounded theory approach was applied. In total, 86 participants with diverse backgrounds were recruited across multiple care settings, including hospitals, ambulance services, primary care centers, municipal home healthcare and home care services. The grounded theory was developed iteratively, based on a combination of observations and interviews, and using constant comparative analysis.

RESULTS: Coordination of care, a complex process that occurs across interconnected healthcare organizations, is manifested as "Negotiating care in organizational borderlands." Care coordination evolves through a spectrum of inter-organizational collaboration, ranging from "Dividing care by disease-specific expertise" to "Establishing paths for collaboration" and ultimately "Co-constructing a comprehensive whole." These categories highlight the challenges of coordinating care across both professional and organizational boundaries. In the multifaceted healthcare landscape, effective care coordination occurs when healthcare professionals actively bridge the divides, leveraging their collective expertise. Importantly, organizational boundaries may serve a purpose and should not be dissolved to facilitate effective care coordination.

CONCLUSIONS: The key to effective care coordination lies in robust inter-organizational collaboration. Even when patients receive integrated care, healthcare professionals may have fragmented roles. This research emphasizes the importance of clearly defined lines of accountability, reinforcing mutual responsibility and facilitating bridging of professional and organizational boundaries. Healthcare professionals and policymakers can use these insights to effectively utilize inter-organizational collaboration in supporting care coordination for patients with complex care needs.

Lean och styrning av processer är allt vanligare styrmetoder i hälso- och sjukvården. Introducerandet sker med förhoppning om ökad effektivitet: inte genom att alla springer snabbare, utan genom ett mer väl genomtänkt och planerat arbete. På så sätt kan onödiga moment reduceras, misstag minskas och mer värde för patienter skapas. Lean har införts på olika sätt i olika organisationer men har en kärna i dess betoning av helhetssyn och processer. Ambitionen i denna bok är att utifrån hälso-och sjukvårdens förutsättningar ge en nyanserad bild av fenomenet.

Multiple organizational social media (MOSM) foster new ways of communication, interaction and new encounters for organizations that can cause stress. There is a lack of studies focusing on both positive and negative stressors deriving from social media. In this study, both negative and positive stressors and strains deriving from using MOSM are studied in an international hotel chain with employees in eight European countries over a period of seven years. The results indicate that techno stressors such as work overload, work-life conflict, and changing algorithms create negative stressors. However, positive stressors such as the ability to create new ways of providing service were also found. The study makes a theoretical contribution to technostress research in the Information Systems research field by uncovering both positive and negative stressors and strains created over time as well as suggesting a development of the Person-Technology fit model.

Background: Because of the high unhealthy rates among women in the com-mune a project to reduce it have begun. For this reason we have been given the mission from the commune of Sotenäs to study the character of these women's health. Objective: To study the health among permanent employed women in the commune of Sotenäs. Method: Quantitative method. The data have been collected through question-naire survey. The purpose of choosing this method was to be able to see connec-tions between various variables. Result: A large number of women who do not have time to carry out their duties during ordinary working hours have experienced that they are tense and anxious, which means that this mental demand may have affected women's health. The study reveals that many of the women who have not received enough informa-tion from their employer to perform their duties have experienced that they are worn out. The majority of women who lacked in development opportunities at work felt tense. These results imply that small decision latitudes could be one of the explanations of a lower level of health among women. The study identified a number of potential explanations for the sick leave in the commune, as the women felt tense and anxious. Adequate emotional support from friends and family, and a satisfactory everyday social life was related to a low degree of anxiety. A good distribution of practical domestic duties at home was a factor related to a low degree of tension among the permanent employed women in the commune of Sotenäs.

Healthcare is a major welfare challenge for many of the world's countries, which necessitates whole system changes in the healthcare sector. This is often done by introducing integrated care, which aims to make health care more efficient through increased inter-organizational cooperation between care providers, with the aim of increasing the quality for patients. Previous research indicates that change management with integrated care fails as a lack of management structure and collaborative management means, why integration between macro and micro level when it comes to change management fails. First-line managers in elderly care are central agents of change when integrated care is to be implemented. The purpose of this qualitative interview study is to examine the leadership's prerequisites regarding change management with a whole system change in Swedish welfare. In this study, it takes place via Nära vård as an empirical example of integrated care. Based on the study's constructivist approach, fourteen semi-structured interviews have been conducted with firstline managers in municipal elderly care. Based on the study's central research questions, the informants described their conditions regarding change management with integrated care and opportunities and obstacles in change management. Prosci's change management model ADKAR has been applied in the analysis of empirical material and the theoretical framework. The study shows that there are several connections between the study's theory and empirical work, but that there are also differences. Conclusions are that the lack of resources and priorities, deficiencies in the strategic management, weak management capacity and the lack of a functioning internal collaboration structure are hindering factors when first-line managers in elderly care participate in change management regarding major system changes. Regarding national goals with integrated care and for the system change to be realized, an active and committed leadership is required at all system levels in order for change management to be possible. This study contributes with increased knowledge that, despite a lack of support, structures for cooperation and priorities from the organization's management, first-line managers can maintain a commitment to change management regarding system changes, even if infrastructural and inter-organizational obstacles exist.

From a salutogenic perspective, relational and reflective competencies are key to the success of competence building. Reflecting on and exploring one’s (life) experience in a continuous learning process can enhance salutogenic competence.

This chapter, whose authors have many years of experience building health professionals’ salutogenic competence, is nicely illustrated with teaching and coaching examples drawn from (a) a master’s programme for students in various health professions, (b) salutogenic talk-therapy groups, (c) students in health promotion training programmes, and (d) on-the-job training of healthcare professionals working in childcare services.

The chapter discusses the concept of “self-tuning,” referring to habitual self-sensitivity, reflection, and mobilising of resources, which can play a central role in all types of training. This chapter emphasises that trainers should strive to “live the talk,” developing their personal salutogenic capacity – in other words, do what you teach and be what you teach.

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.

Patients diagnosed with stress induced exhaustion disorder (ED) often require long sick leave before returning to work. The aim of this study was to describe the experiences of physiotherapists and occupational therapists with respect to interprofessional collaboration and treatment strategies for patients diagnosed with ED. This study has an explorative qualitative design and was conducted as an interview study using a semi-structured question guide. All interviews were tape-recorded and transcribed verbatim. The interviews were conducted at 14 different rehabilitation centres with 12 physiotherapists and 3 occupational therapists. Six of these centres were run within the public sector and 9 were run by private suppliers. The informants had an average of 17 years of experience in their profession, with a range of 4–49 years. The interviews were analysed by means of qualitative inductive content analysis, where the manifest as well as the latent content became visual. The analysis resulted in an overall theme: Equitable care—a strategy on feet of clay, supported by three main categories (a) rehabilitation centres- an isolated island, (b) evidence-based treatments- under the radar (c) patient participation-a double-edged sword. The current organizational structure of rehabilitation centers within Swedish primary health care falls short in meeting the integrated and collaborative care requirements for patients with stress-related exhaustion disorder (ED). Furthermore, the absence of evidence-based treatments poses a challenge in devising personalized and appropriately timed treatment strategies. 

Föreliggande rapport har tillkommit utifrån ett uppdrag till Högskolan Väst från Hälsoäventyret Oasen Vara. Uppdraget innebar att ”klargöra teoribasen bakom upplevelsebaserad pedagogik” och som en del av detta uppdrag gjordes en diskursanalytisk studie på Hälsoäventyrets egen skriftliga presentation, vilken här presenteras. Datamaterialet är hämtat dels från verksamhetens egen webbsida och dels från dess tryckta publikationer. Syftet med rapporten är att ge en överskådlig bild av vilka diskurser samt hur dessa diskurser formerar sig i texterna. Vidare är syftet att problematisera dessa diskurser samt öppna upp för eventuella alternativa synsätt, vilka skulle kunna ses om relevanta för området. Analysen inriktas på att lyfta upp meningsskapande processer, vilka ibland kan vara motsägelsefulla, för att på så sätt klargöra vilka idéer och föreställningar som är privilegierande och tilldelas status som sanningar. Vilka gränsdragningar görs i samband med presentationen av upplevelsebaserad pedagogik och vilka effekter och konsekvenser skapas med utgångspunkt i de skilda diskursiva konstruktionerna? Tre centrala diskurser framträder i texterna: Upplevelsebaserad pedagogik som lärande, upplevelsebaserad pedagogik som fostran samt upplevelsebaserad pedagogik som terapi. De tre diskurserna kan ses som innehållande en inbyggd motsättning men med vissa gemensamma beröringspunkter. I rapporten diskuteras hur förståelsen och tolkningen av pedagogiska praktiker med hjälp av fostrande och/eller terapeutiska inslag kan ses som problematiskt utifrån synen på lärande respektive synen på barn och unga. Vidare diskuteras hur lärandediskursens inriktning mot det estetiska området kan förstås och problematiseras. En alternativ diskurs, skapad utifrån såväl innehåll (hälsoaspekter) som form (estetiskt- konstnärliga uttryck), framställs som fruktbar för den fortsatta utvecklingen av begreppet ”upplevelsebaserad pedagogik”.