Abstract:
BACKGROUND:Comprehensive policies are becoming common for addressing wicked problems in health and social care. Success of these policies often varies between target organizations. This variation can often be attributed to contextual factors. However, there is a lack of knowledge about the conditions for successful policy implementation and how context influences this process. The aim of this study was to investigate county-level actors' perspectives on the implementation of a comprehensive national policy in three Swedish counties. The policy focused on developing quality of care for elderly based on the use of national quality registries (NQRs) and to improve coordination of care. METHODS:A comparative case study approach was used. Data was collected longitudinally through documents and interviews. The Consolidated Framework for Implementation Research (CFIR) guided the analysis. RESULTS:All three counties shared the view that the policy addressed important issues. Still, there was variation regarding how it was perceived and managed. Adaptable features-i.e., NQRs and improvement coaches-were perceived as relevant and useful. However, the counties differed in their perceptions of another policy component-i.e., senior management program-as an opportunity or a disturbance. This program, while tackling complex issues of collaboration, fell short in recognizing the counties' pre-existing conditions and needs and also offered few opportunities for adaptations. Performance bonuses and peer pressure were strong incentives for all counties to implement the policy, despite the poor fit of policy content and local context. CONCLUSIONS:Comprehensive health policies aiming to address wicked problems have better chances of succeeding if the implementation includes assessments of the target organizations' implementation capacity as well as the implicit quid pro quos involved in policy development. Special attention is warranted regarding the use of financial incentives when dealing with wicked problems since the complexity makes it difficult to align incentives with the goals and to assess potential consequences. Other important aspects in the implementation of such policies are the use of collaborative approaches to engage stakeholders with differing perspectives, and the tailoring of policy communication to facilitate shared understanding and commitment.
journal_name
BMC Health Serv Resjournal_title
BMC health services researchauthors
Strehlenert H,Hansson J,Nyström ME,Hasson Hdoi
10.1186/s12913-019-4591-2subject
Has Abstractpub_date
2019-10-22 00:00:00pages
730issue
1issn
1472-6963pii
10.1186/s12913-019-4591-2journal_volume
19pub_type
杂志文章abstract:BACKGROUND:Japan has the highest rate of aging. To contain Long-Term Care (LTC) Insurance costs, the Japanese government is attempting to increase the proportion of individuals receiving home care services. However, demand for institutional care is increasing. These circumstances will decrease the sustainability of the...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-017-2293-1
更新日期:2017-05-15 00:00:00
abstract:BACKGROUND:Fever is a common reason for attending primary health facilities in Vietnam. Response of health care providers to patients with fever commonly consists of making a presumptive diagnosis and proposing corresponding treatment. In Vietnam, where malaria was brought under control, viral infections, notably dengu...
journal_title:BMC health services research
pub_type: 杂志文章,随机对照试验
doi:10.1186/1472-6963-10-275
更新日期:2010-09-21 00:00:00
abstract:BACKGROUND:Healthcare providers operate in a unique industry characterized by pursuit of perhaps the most noble of missions: the delivery of vital health and medical services to those in need. Distinguishing features abound, differentiating the healthcare industry from others, with such facets having the potential to c...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-017-2342-9
更新日期:2017-07-11 00:00:00
abstract:BACKGROUND:The Health Literacy Questionnaire (HLQ) has nine scales that each measure an aspect of the multidimensional construct of health literacy. All scales have good psychometric properties. However, it is the interpretations of data within contexts that must be proven valid, not just the psychometric properties of...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-017-2254-8
更新日期:2017-04-27 00:00:00
abstract:BACKGROUND:Nursing and midwifery research activity is an important indicator of the quality of healthcare services and the status of nursing profession. The main aim of this study was to assess the research activity in nursing and midwifery field in Arab countries. METHOD:The current study implemented bibliometric met...
journal_title:BMC health services research
pub_type: 杂志文章,评审
doi:10.1186/s12913-019-4178-y
更新日期:2019-05-28 00:00:00
abstract:BACKGROUND:For mothers who have just given birth, the postpartum hospital stay is meant to promote an environment where resting, healing and bonding can take place. New mothers, however, face many interruptions throughout the day including multiple visitors and noise caused by medical equipment, corridor conversations ...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-014-0604-3
更新日期:2014-11-29 00:00:00
abstract:BACKGROUND:Continuity of care has been explored largely from academic and service provider perspectives, and in relation to adult patient/client groups. We interviewed parents of children with complex chronic health conditions to examine how their experiences and perceptions of continuity of care fit with these perspec...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-9-242
更新日期:2009-12-21 00:00:00
abstract:BACKGROUND:An estimated 65,000 abortions occurred in Zimbabwe in 2016, and 40 % resulted in complications that required treatment. Quality post-abortion care (PAC) services are essential to treat abortion complications and prevent future unintended pregnancies, and there have been recent national efforts to improve PAC...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-020-05110-y
更新日期:2020-03-24 00:00:00
abstract:BACKGROUND:Patient-centered care ideally considers patient preferences, values and needs. However, it is unclear if policies such as wait time strategies for hip and knee replacement surgery (TJR) are patient-centred as they focus on an isolated episode of care. This paper describes the accounts of people scheduled to ...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-13-531
更新日期:2013-12-23 00:00:00
abstract:BACKGROUND:In the organization of health care and health care systems, there is an increasing trend towards integrated care. Policy-makers from different countries are creating policies intended to promote cooperation and collaboration between health care providers, while facilitating the integration of different healt...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-020-4950-z
更新日期:2020-02-21 00:00:00
abstract:BACKGROUND:The clinical environment in which health care providers have to work everyday is highly complex; this increases the risk for the occurrence of unintended events. The aim of this randomised controlled trial is to improve patient safety for a vulnerable group of patients that have to go through a complex care ...
journal_title:BMC health services research
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1186/1472-6963-11-59
更新日期:2011-03-21 00:00:00
abstract:BACKGROUND:Given the documented benefits of Patient Own Drugs (PODs) in most developed countries and scanty data on PODs management in developing countries the aim of the study was to evaluate the assessment, quality and extent of PODs use among hospitalised patients. Furthermore the perceived benefits and challenges i...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-018-3860-9
更新日期:2019-01-11 00:00:00
abstract:BACKGROUND:World Health Organisation recommends routine Human Papilloma Virus (HPV) vaccination for girls when its cost-effectiveness in the country or region has been duly considered. We therefore aimed to evaluate cost-effectiveness of HPV vaccination in Nigeria using pragmatic parameter estimates for cost and progra...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-017-2758-2
更新日期:2017-12-08 00:00:00
abstract:BACKGROUND:The treatment gap for epilepsy is considerable in low and middle-income countries. In the Lao PDR it is estimated at over 90%. Health workers play a significant role in bridging the gap between people with epilepsy (PWE) and access to epilepsy care. In a national survey we assessed: 1) the knowledge and prac...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-13-41
更新日期:2013-02-04 00:00:00
abstract:BACKGROUND:In 2008, the Swedish government introduced a National Rehabilitation Program, in which the government financially reimburses the county councils for evidence-based multimodal rehabilitation (MMR) interventions. The target group is patients of working age with musculoskeletal disorders (MSD), expected to retu...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-016-1948-7
更新日期:2017-01-07 00:00:00
abstract:BACKGROUND:Measurement of healthcare spatial access over a network involves accounting for demand, supply, and network structure. Popular approaches are based on floating catchment areas; however the methods can overestimate demand over the network and fail to capture cascading effects across the system. METHODS:Optim...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-015-0919-8
更新日期:2015-07-17 00:00:00
abstract:BACKGROUND:Cost information is important for efficient allocation of healthcare expenditure, estimating future budget allocation, and setting user fees to start new financing systems. Myanmar is in political transition, and trying to achieve universal health coverage by 2030. This study assessed the unit cost of health...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-017-2619-z
更新日期:2017-09-19 00:00:00
abstract:BACKGROUND:By tradition, the Swedish health care system is based on a representative and parliamentary form of government. Recently, new management forms, inspired by market principles, have developed. The steering system is both national and regional, in that self-governing county councils are responsible for the fina...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-018-3436-8
更新日期:2018-08-06 00:00:00
abstract:BACKGROUND:Attempts to reduce high utilisation of psychiatric inpatient care by targeting the critical time of hospital discharge have been rare. METHODS:This paper presents design and methods of the study "Effectiveness and Cost-Effectiveness of Needs-Oriented Discharge Planning and Monitoring for High Utilisers of P...
journal_title:BMC health services research
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1186/1472-6963-8-152
更新日期:2008-07-21 00:00:00
abstract:BACKGROUND:Training is a critical part of health information technology implementations, but little emphasis is placed on post-implementation training to support day-to-day activities. The goal of this study was to evaluate the impact of post-implementation training on key electronic health record activities. METHODS:...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-13-503
更新日期:2013-12-02 00:00:00
abstract:BACKGROUND:Proton pump inhibitors (PPIs) remain one of the world's most frequently prescribed medications and there is a growing number of publications on correct versus incorrect use of PPIs worldwide. The objective of this observational retrospective study was to assess changes in PPI prescribing trends over the past...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-018-3358-5
更新日期:2018-07-11 00:00:00
abstract:BACKGROUND:Ghana has been providing HIV and AIDS services since the identification of the first case in 1986 and added highly active antiretroviral therapy to its comprehensive care in 2003.This study aimed at assessing availability of HIV services along the continuum of HIV care in Ghana. METHOD:A cross sectional stu...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-018-3485-z
更新日期:2018-09-26 00:00:00
abstract:BACKGROUND:Elder abuse in nursing homes is a complex multifactorial problem and entails various associations across personal, social, and organisational factors. One way leaders can prevent abuse and promote quality and safety for residents is to follow up on any problems that may arise in clinical practice in a way th...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-020-05969-x
更新日期:2020-12-01 00:00:00
abstract:BACKGROUND:There is a growing number of adolescents and young adults living with HIV (YPLHIV) who require the transfer of care from pediatric/ adolescent clinics to adult Antiretroviral therapy (ART) clinics. A successful transition is critical for optimum health outcomes, yet facilities may lack infrastructure, human ...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-020-05701-9
更新日期:2020-09-05 00:00:00
abstract:BACKGROUND:The use of increasingly complex payment schemes in primary care may represent a barrier to recruiting general practitioners (GP). The existing Norwegian remuneration system is fully activity based - 2/3 fee-for-service and 1/3 capitation. Given that the system has been designed and revised in close collabora...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-12-68
更新日期:2012-03-20 00:00:00
abstract:BACKGROUND:Recognizing the importance of increased patient participation in healthcare decisions leads decision makers to consider effective ways to incorporate patient perspectives in Health Technology Assessment (HTA) processes. The implementation of local health HTA units in university hospitals in Quebec provides a...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-9-54
更新日期:2009-03-27 00:00:00
abstract:BACKGROUND:Safety management systems have been set up in healthcare institutions to reduce the number of adverse events. Safety management systems use a combination of activities, such as identifying and assessing safety risks in the organizational processes through retrospective and prospective risk assessments. A com...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-14-103
更新日期:2014-03-03 00:00:00
abstract:BACKGROUND:Authors in previous studies demonstrated that centralising acute stroke care is associated with an increased chance of timely Intra-Venous Thrombolysis (IVT) and lower costs compared to care at community hospitals. In this study we estimated the lower bound of the causal impact of centralising IVT on health ...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-020-4959-3
更新日期:2020-02-10 00:00:00
abstract:BACKGROUND:After election in 1994, the South African government implemented national and regional programmes, such as the Wild Coast Spatial Development Initiative (SDI), to provoke economic growth and to decrease inequities. CIET measured development in the Wild Coast region across four linked cross-sectional surveys ...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-11-S2-S5
更新日期:2011-12-21 00:00:00
abstract:BACKGROUND:Drug prescribing errors are frequent in the hospital setting and pharmacists play an important role in detection of these errors. The objectives of this study are (1) to describe the drug prescribing errors rate during the patient's stay, (2) to find which characteristics for a prescribing error are the most...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-10-13
更新日期:2010-01-12 00:00:00