Avby Gunilla, Kjellström Sofia, Andersson Bäck Monica
The Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Box 1026, 551 11, Jönköping, Sweden.
Department of Social Work, University of Gothenburg, Box 720, 405 30, Göteborg, Sweden.
BMC Health Serv Res. 2019 Jan 18;19(1):42. doi: 10.1186/s12913-019-3874-y.
Policymakers in many countries are involved in system reforms that aim to strengthen the primary care sector. Sweden is no exception. Evidence suggests that targeted financial micro-incentives can stimulate change in certain areas of care, but they do not result in more radical change, such as innovation. The study was performed in relation to the introduction of a national health care reform, and conducted in Jönköping County Council, as the region's handling of health care reforms has attracted significant national and international interest. This study employed success case method to explore what enables primary care innovations.
Five Primary Health Care Centres (PHCCs) were purposively selected to ensure inclusion of a variety of aspects, such as size, location, ownership and regional success criteria. 48 in-depth interviews with managers and staff at the recruited PHCCs were analysed using content analyses. The COREQ checklist for qualitative studies was used to assure quality standards.
This study identified three types of innovations, which break with previous ways of organizing work at these PHCCs: (1) service innovation; (2) process innovation; and (3) organizational innovation. A learning-oriented culture and climate, comprising entrepreneurial leadership, cross-boundary collaboration, visible and understandable performance measurements and ability to adapt to external pressure were shown to be advantageous for innovativeness.
This qualitative study highlights critical features in practice that support primary care innovation. Managers need to consistently transform and integrate a policy "push" with professionals' understanding and values to better support primary care innovation. Ultimately, the key to innovation is the professionals' engagement in the work, that is, their willingness, capability and opportunity to innovate.
许多国家的政策制定者都参与了旨在加强初级保健部门的系统改革。瑞典也不例外。有证据表明，有针对性的小额财政激励措施可以刺激某些护理领域的变革，但不会带来更激进的变革，如创新。这项研究是在一项全国医疗改革推出之际进行的，在延雪平郡议会开展，因为该地区对医疗改革的处理方式引起了国内外的广泛关注。本研究采用成功案例法来探索促成初级保健创新的因素。
有目的地选择了五个初级卫生保健中心（PHCC），以确保涵盖各个方面，如规模、位置、所有权和地区成功标准。对所招募的初级卫生保健中心的管理人员和工作人员进行了48次深入访谈，并采用内容分析法进行分析。使用定性研究的COREQ清单来确保质量标准。
本研究确定了三种类型的创新，这些创新打破了这些初级卫生保健中心以前的工作组织方式：（1）服务创新；（2）流程创新；（3）组织创新。一种以学习为导向的文化和氛围，包括创业型领导、跨部门协作、可见且易懂的绩效衡量以及适应外部压力的能力，被证明对创新具有促进作用。
这项定性研究突出了实践中支持初级保健创新的关键特征。管理者需要持续地将政策“推动”与专业人员的理解和价值观相结合，以更好地支持初级保健创新。最终，创新的关键在于专业人员对工作的投入，即他们创新的意愿、能力和机会。
