Nyström M E, Höög E, Garvare R, Andersson Bäck M, Terris D D, Hansson J
Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE 171 77, Stockholm, Sweden.
Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, SE 901 87, Umeå, Sweden.
BMC Health Serv Res. 2018 May 24;18(1):376. doi: 10.1186/s12913-018-3129-3.
Eldercare and care of people with functional impairments is organized by the municipalities in Sweden. Improving care in these areas is complex, with multiple stakeholders and organizations. Appropriate strategies to develop capability for continuing organizational improvement and learning (COIL) are needed. The purpose of our study was to develop and pilot-test a flexible, multilevel approach for COIL capability building and to identify what it takes to achieve changes in key actors' approaches to COIL. The approach, named "Sustainable Improvement and Development through Strategic and Systematic Approaches" (SIDSSA), was applied through an action-research and action-learning intervention.
The SIDSSA approach was tested in a regional research and development (R&D) unit, and in two municipalities handling care of the elderly and people with functional impairments. Our approach included a multilevel strategy, development loops of five flexible phases, and an action-learning loop. The approach was designed to support systems understanding, strategic focus, methodological practices, and change process knowledge - all of which required double-loop learning. Multiple qualitative methods, i.e., repeated interviews, process diaries, and documents, provided data for conventional content analyses.
The new approach was successfully tested on all cases and adopted and sustained by the R&D unit. Participants reported new insights and skills. The development loop facilitated a sense of coherence and control during uncertainty, improved planning and problem analysis, enhanced mapping of context and conditions, and supported problem-solving at both the individual and unit levels. The systems-level view and structured approach helped participants to explain, motivate, and implement change initiatives, especially after working more systematically with mapping, analyses, and goal setting.
An easily understood and generalizable model internalized by key organizational actors is an important step before more complex development models can be implemented. SIDSSA facilitated individual and group learning through action-learning and supported systems-level views and structured approaches across multiple organizational levels. Active involvement of diverse organizational functions and levels in the learning process was facilitated. However, the time frame was too short to fully test all aspects of the approach, specifically in reaching beyond the involved managers to front-line staff and patients.
在瑞典，老年人护理和功能障碍者护理由各市镇负责组织。改善这些领域的护理工作十分复杂，涉及多个利益相关者和组织。需要制定适当的策略来培养持续组织改进和学习（COIL）的能力。我们研究的目的是开发并试点测试一种灵活的多层次方法来进行COIL能力建设，并确定实现关键行为者COIL方法转变所需的条件。该方法名为“通过战略和系统方法实现可持续改进与发展”（SIDSSA），通过行动研究和行动学习干预来应用。
SIDSSA方法在一个区域研发（R&D）单位以及两个负责老年人和功能障碍者护理的市镇进行了测试。我们的方法包括多层次策略、五个灵活阶段的发展循环以及一个行动学习循环。该方法旨在支持系统理解、战略重点、方法实践和变革过程知识——所有这些都需要双环学习。多种定性方法，即重复访谈、过程日记和文件，为传统内容分析提供了数据。
新方法在所有案例中均成功测试，并被研发单位采用和持续应用。参与者报告了新的见解和技能。发展循环在不确定性期间促进了连贯感和控制感，改善了规划和问题分析，增强了对背景和条件的映射，并支持了个人和单位层面的问题解决。系统层面的观点和结构化方法帮助参与者解释、推动和实施变革举措，尤其是在更系统地进行映射、分析和目标设定之后。
在实施更复杂的发展模型之前，关键组织行为者内化一个易于理解且可推广的模型是重要的一步。SIDSSA通过行动学习促进了个人和团队学习，并支持了多个组织层面的系统层面观点和结构化方法。促进了不同组织职能和层面积极参与学习过程。然而时间框架太短，无法全面测试该方法的所有方面，特别是在涉及范围超越参与的管理人员至一线工作人员和患者方面。
