The chosen research area is the communication in complex hospital construction projects. The purpose of this study is to investigate and map out the existing communication and cooperation between the project management organisation towards the steering committee and the hospital organisation. The research objective consists also of investigating how the project members manages the challenges and difficulties with communication and what improvements they think is needed for increasing the efficiency within the different organisations, within the project.   The results create an understanding and an awareness of the challenges, which will hopefully be beneficial for a more efficient project management. This was possible by investigating two actual projectorganisations in Sweden, one in Gävleborg (Gävle and Hudiksvall) and another one in Stockholm.  Extensive literature review and various scientific reports were investigated. An overview over the research area was achieved, with focus on existing problems and possible solutions. The communication in the project process was analysed by having semi- structured interviews. One of the objectives with the interviews is to expose the strengths and weaknesses in the project management, but also the external opportunities and threats towards the organisation. It can further be described as an analysis for representing how the project members use their competence and experience to handle the challenges and difficulties, how the optimal solutions could be according to the project members and also how the organizational structure should be conducted for a better communication in the project process. The findings from the interviews compared with the theoretical framework indicates some parameters for achieving an ideal information transfer and communication. There needs to be defined structures and techniques for information transfer. The effectiveness of information transfer increases, when the roles of different project members, groups and organisation structures are clearly defined, in a formal structured way. The culture in the organisation impacts and shapes the communication methods within the organisation. The work environment, values, language, routines, structure and experience in the organisation shapes and creates the foundation for the organisational culture, which leads to how the communication will take form. The attitudes and behaviours of the participants in the project are another impact on the communication structure. The organisation should secure in a personal level openness and commitments for the sake of fulfilling the common objectives and vision of the project.  The main challenges that were common in the projects in Gävle and Hudiksvall have been the lack of commitment from the steering committee, which is the county councils. The lack of participation and experience from both the steering committee and the hospital organisation made it challenging for the project management organisation to manage the projects. This means also that the hospital organisation has not been organized and there are not any representatives from the hospital in the projects. The project members are in these cases making qualified assumptions regarding the requirements that are needed in the hospital organisation. The main thought of effective communication is to be aware of all the changes in the project.  If the participating project members are updated with the latest information, then there are less risks for surprises. The project management organisation and the hospital organisation needs mutually to support each other with guidance through the needs and requirements that they have. This could be possible if they organisation could have continuously face-to-face meetings but also by keeping a good dialogue with each other. The representatives for the hospital organisation should also be prepared for the project from the initialisation phase. / Det valda undersöknings området är kommunikationen i komplexa sjukhus byggprojekt. Syftet med studien är att undersöka och kartlägga den existerande kommunikationen och samarbetet mellan projektledningsorganisationen gentemot styrgruppen och sjukhusverksamheten. Målet med undersökningen består av att undersöka hur projektmedlemmarna handskas med utmaningarna och svårigheterna med kommunikationen och vilka förbättringar som de anser behövs för att öka effektiviteten i de olika organisationerna. Resultatet skapar en förståelse och en medvetenhet om svårigheterna, vilket förhoppningsvis blir mer fördelaktigt för en effektivare projektledning. Undersökningen var möjlig att genomföra genom att två aktuella projektorganisationer undersöktes i Sverige, en i Gävleborg (Gävle och Hudiksvall) och en annan i Stockholm.  En omfattande litteraturstudie genomfördes och varierande forskningsartiklar undersöktes. En översikt över undersökningsområdet var uppnådd, med fokus på existerande problem och möjliga lösningar. Kommunikationen i projekten var analyserad genom att ha semi-strukturerade intervjuer. Ett av målen med intervjuerna var att upplysa styrkorna och svagheterna i projektledningen, men även de externa möjligheterna och farorna gentemot organisationen. Det kan vidare beskrivas som en analys som uttrycker hur projektmedlemmarna använder sin kompetens och erfarenhet för att handskas med utmaningarna och svårigheterna, hur de optimala lösningarna kan vara enligt projektmedlemmarna och även hur den organisatoriska strukturen borde genomföras för bättre kommunikation i projekt processen. Resultatet från intervjuerna jämfört med det teoretiska ramverket resulterar i vissa parametrar för att uppnå en ideal informationsöverföring och kommunikation. Det behöver finnas definierade strukturer och tekniker för informationsöverföring. Effektiviteten med informationsöverföring ökar när rollerna av de olika projektmedlemmarna, grupperna och organisationerna är tydligt definierade, i ett formellt strukturerat sätt. Organisationskulturen påverkar och formar kommunikationsmetoderna inom organisationen. Arbetsmiljön, värderingar, språk, rutiner, struktur och erfarenheter i organisationen formar och skapar grunden för den organisatoriska kulturen, vilket leder till hur kommunikationen formas. Attityd och beteenden från deltagare i projekten är ytterligare en påverkan på kommunikationsstrukturen. Organisationen borde säkra öppenhet och engagemang på individnivå för att kunna uppfylla de gemensamma målen och visionen för projektet. De huvudsakliga svårigheterna som var gemensamma för projekten i Gävle och Hudiksvall, har varit bristen på engagemang från styrgruppen, alltså landstingen. Bristen på deltagande och erfarenhet från både styrgruppen och sjukhusverksamheten har försvårat projektledningen för projektlednings organisationen. Det betyder också att sjukhusverksamheten inte har varit organiserade och att det inte har funnits representanter från sjukhusverksamheten. Projektmedlemmarna har i dessa situationer gjort kvalificerade gissningar angående de behov som sjukhusverksamheten har. Det huvudsakliga med effektiv kommunikation är att vara medveten om alla förändringar i projektet. Om de deltagande projektmedlemmarna är uppdaterade med den senaste informationen, blir det mindre risker för några överraskningar. Projektledningsorganisationen och sjukhusverksamheten behöver gemensamt stötta varandra genom vägledning av de behov och krav som de har. Detta kan vara möjligt om man har kontinuerliga face-to-face möten men även att hålla en god dialog med varandra. Representanterna för sjukhusverksamheten borde vara förberedda för projektet från initialiseringsfasen.

<p>The aim with this independent degree project of master thesis is to find what the user opinions of the intranet in a county council is. The paper seeks how the question about how the culture in the organisation was affected by the use of the intranet. An important part is to explore the expectations and acceptance of the intranet and get a picture of which functions and services support day-to-day work with good quality. One goal is to find out how the intranet users feel that the communication, information and usability can be developed.</p><p>The focus group interview is a qualitative method that has been applied for gathering data from the respondents, who participate in the investigation from the county council. The used method is unstructured focus groups containing the three dominating categories of staff in the county council. Totally five focus groups have been interviewed.</p><p>In the result and the following analysis of data from the focus group interviews have a few main categories been chosen for the survey. One of the categories is the information- and communication flows in the intranet, which include how it works today and could be improved. Other parts in the analysis are usability, organisation culture and the potential for the intranet as a tool for the organisation.</p><p>A number of conclusions are drawn from the survey and the analysis. One conclusion is that the intranet is a well-accepted channel for information, but underestimated as a communication channel. Another conclusion is that the respondents considered that an intranet has to be fun, exciting, and contain interesting material; which will lead to that the intranet will be used more. The content has to be updated and suited for the needs of the organisation.</p>

<p>Syftet med studien är att undersöka hur samverkan ser ut mellan kommun och landsting vad</p><p>avser personer som vårdas enligt lag (1991:1129) om rättspsykiatrisk vård (LRV) och skall</p><p>permitteras till hemkommunen. Studiens frågeställningar är: (1) Hur sker samverkan mellan</p><p>kommun och landsting innan permissionen verkställs?</p><p>(2) Hur sker samverkan mellan kommun och landsting under tiden en person är permitterad?</p><p>(3) Vilka möjligheter och hinder finns vad avser samverkan mellan kommun och landsting gällande personer som permitterats?</p><p>Metodvalet är kvalitativt och författarna har genomfört fem intervjuer med nyckelpersoner</p><p>inom landsting och samverkande kommuner. Den teoretiska utgångspunkten är Danermarks</p><p>tre primära samverkansbegrepp: organisation, kunskap och regelverk. Resultatet visar att</p><p>landstinget har ansvar för vård och behandling och att kommunen har ansvar för boende och</p><p>sysselsättning. Respondenterna inom landstinget upplever att deras samverkan fungerar bra</p><p>och uttrycker att det är vikigt med en god kommunikation samt att personkännedom</p><p>underlättar samverkan. I dagsläget saknas det skriftliga samverkansavtal som är förankrade i</p><p>verksamheterna, det saknas även en klar målsättning för samverkan. Detta är något som</p><p>studiens tidigare forskning rekommenderar för en förbättrad samverkan. Respondenterna i en</p><p>av kommunerna upplever att de får för lite bakgrundshistorik om brukarna och anser att viss</p><p>rädsla kan finnas på grund av detta. De anser även att den handledning de idag får ifrån</p><p>landstingets personal inte är tillräcklig. En respondent ifrån landstinget tycker dock att de ger</p><p>lagom mycket information och att rädslan skulle kunna öka bland kommunens personal om de</p><p>gav mer information.</p> / <p>The aim of this study is to research how the collaboration between municipality and county</p><p>council works, about persons who are in forensic psychiatric care and are going on</p><p>community leave. The studied issues are: (1) How does the collaboration work, between the</p><p>municipality and county council, before the community leave is carried out? (2) How does the</p><p>collaboration work, between the municipality and county council, during the community</p><p>leave? (3) Witch possibilities and obstacles can be found in the collaboration between the</p><p>municipality and county council, about persons who are on community leave?</p><p>The method in the study is qualitative and the authors have accomplished five interviews with</p><p>key figures within county council and collaborating municipalities. The theoretical starting</p><p>point is Danermarks three collaboration concepts: organization, knowledge and rules. The</p><p>result shows that the county council has the responsibility of medical care and treatment and</p><p>that the municipality has the responsibility of the housing and occupation. The county council</p><p>respondents experience that the collaboration is good and they also express that it is important</p><p>to have an open communication, and that good knowledge of the persons involved facilitates</p><p>the collaboration. Today there is a lack of written collaboration agreements that have gained</p><p>approval within the organizations. Also, there is no common aim with the collaboration. A</p><p>written agreement with a clear aim for the collaboration is something that is recommended by</p><p>earlier research to improve the collaboration. The respondents in one municipality would like</p><p>to get more background history about the persons who are on community leave, the lack of</p><p>information could cause fear among the employees. They would also like some more</p><p>guidance from the county council staff. One county council employee thinks that more</p><p>information would cause more fear amongst the municipality staff.</p>

Syftet med studien är att undersöka hur samverkan ser ut mellan kommun och landsting vad avser personer som vårdas enligt lag (1991:1129) om rättspsykiatrisk vård (LRV) och skall permitteras till hemkommunen. Studiens frågeställningar är: (1) Hur sker samverkan mellan kommun och landsting innan permissionen verkställs? (2) Hur sker samverkan mellan kommun och landsting under tiden en person är permitterad? (3) Vilka möjligheter och hinder finns vad avser samverkan mellan kommun och landsting gällande personer som permitterats? Metodvalet är kvalitativt och författarna har genomfört fem intervjuer med nyckelpersoner inom landsting och samverkande kommuner. Den teoretiska utgångspunkten är Danermarks tre primära samverkansbegrepp: organisation, kunskap och regelverk. Resultatet visar att landstinget har ansvar för vård och behandling och att kommunen har ansvar för boende och sysselsättning. Respondenterna inom landstinget upplever att deras samverkan fungerar bra och uttrycker att det är vikigt med en god kommunikation samt att personkännedom underlättar samverkan. I dagsläget saknas det skriftliga samverkansavtal som är förankrade i verksamheterna, det saknas även en klar målsättning för samverkan. Detta är något som studiens tidigare forskning rekommenderar för en förbättrad samverkan. Respondenterna i en av kommunerna upplever att de får för lite bakgrundshistorik om brukarna och anser att viss rädsla kan finnas på grund av detta. De anser även att den handledning de idag får ifrån landstingets personal inte är tillräcklig. En respondent ifrån landstinget tycker dock att de ger lagom mycket information och att rädslan skulle kunna öka bland kommunens personal om de gav mer information. / The aim of this study is to research how the collaboration between municipality and county council works, about persons who are in forensic psychiatric care and are going on community leave. The studied issues are: (1) How does the collaboration work, between the municipality and county council, before the community leave is carried out? (2) How does the collaboration work, between the municipality and county council, during the community leave? (3) Witch possibilities and obstacles can be found in the collaboration between the municipality and county council, about persons who are on community leave? The method in the study is qualitative and the authors have accomplished five interviews with key figures within county council and collaborating municipalities. The theoretical starting point is Danermarks three collaboration concepts: organization, knowledge and rules. The result shows that the county council has the responsibility of medical care and treatment and that the municipality has the responsibility of the housing and occupation. The county council respondents experience that the collaboration is good and they also express that it is important to have an open communication, and that good knowledge of the persons involved facilitates the collaboration. Today there is a lack of written collaboration agreements that have gained approval within the organizations. Also, there is no common aim with the collaboration. A written agreement with a clear aim for the collaboration is something that is recommended by earlier research to improve the collaboration. The respondents in one municipality would like to get more background history about the persons who are on community leave, the lack of information could cause fear among the employees. They would also like some more guidance from the county council staff. One county council employee thinks that more information would cause more fear amongst the municipality staff.

In November 2012 Uppsala County Council (UCC) introduced an eHealth service, ‘My Health Record’, that gives all inhabitants over age 18 in Uppsala County access to their health records online. However, this service has not been evaluated before this study. We conducted an interview study, based on User Experience (UX) and Patient empowerment, with users of ‘My Health Record’ to get their opinions, and to see if and how the service can be improved. Our findings shows that the users are positive to the service and the aspects that can be improved mostly concern information and communication. Based on these results, we propose design principles as well as concrete design proposals which can be useful for re-designing the service as well as inspiration for similar projects. Additionally, an interesting finding is that the interviewees had very few opinions and complains on the actual interface, which could mean that the content (the health record) is so interesting that the interface becomes almost “invisible”. A conclusion we make is that UX and Patient empowerment is a good fit for each other, and that UX has advantages over traditional usability in services like this.

In the presence of challenges arise from ageing populations, increasing incidence of chronic diseases, high health care cost, rapid changes in technological equipment and medical knowledge, eHealth offers tremendous abilities to develop and deliver health care services to the end user that is both seamless and integrated according to the needs and requirements of individuals. Even though the prospective of eHealth is accepted in academia as well as among policy-makers, health care planners and health care practitioners, the implementation of its applications has appeared to be difficult then expectations. In order for successful implementation of eHealth, it is necessary to offer eHealth services according to the citizens and patients expectations. The purpose of this study was to investigate citizens‘ accessing the eHealth services in the county of Blekinge by identifying the accessible, currently accessed, projected and imagined eHealth services. The knowledge from this study would be supportive to the regional health authorities to understand the citizens‘ needs and requirements for a successful delivery of eHealth services in county of Blekinge. In the first phase through extensive review of the literature the eHealth services which are more in health care practices within European countries were identified. On the basis of findings of first phase interviews were conducted to know strategies plans regarding eHealth services. After analysis of interviews, questionnaire was conducted to know the citizens opinions about eHealth services. The authors find that, after understanding the success criteria of effectively running eHealth services within European countries, many eHealth services could be implemented successfully in the county of Blekinge. The rules of interoperability among Hospitals, GP‘s, Primary Cares and Dental Services would provide substantial benefits to citizens and they can access the eHealth services whenever and wherever they want. Moreover in future citizens would have eHealth services according to their expectation. / Farrukh Sahar - 0046 707267187, Muhammad Asim - 0046 737355716

Denna uppsats handlar om integritetskänslig vårdinformation på fakturor, ett ämne som aktualiserats under mitt arbete på landstingets kansli i Jönköping. När en person får vård i annat län än hemlandstinget så skickas en faktura till hemlandstinget och innan dessa fakturor betalas måste de granskas och attesteras. Hanteringen kring detta upplevdes som tidsödande och ineffektiv, vilket ledde mig in på funderingar kring elektronisk fakturering (e-fakturering). Eftersom fakturorna innehåller integritetskänslig information, som personuppgifter och vissa uppgifter som går att koppla till diagnos och behandling, är det inte bara viktigt att hanteringen blir effektiv utan också att sekretessen kan upprätthållas under hela faktureringsprocessen. I denna undersökning studeras hur hanteringen av integritetskänslig vårdinformation påverkas om fakturahanteringen digitaliseras. Syftet är att göra en jämförelse avseende hantering av sekretess mellan pappersfakturor och digitala e-fakturor. Undersökningen genomfördes med en kvalitativ ansats där en organisation, Jönköpings läns landsting, studerades mer ingående och för datainsamlingen valdes litteraturstudier och intervjuer. Resultatet visade att sekretessen kring pappersfakturor är en känslig faktor då hanteringen av dessa inte går att spåra och att fakturor lätt kan försvinna inom organisationen. För e-fakturor finns däremot stor möjlighet till spårbarhet och kontroll över händelserna kring hanteringen. Det finns olika typer av e-fakturering och om ett system som till exempel EDI-fakturering väljs kan många uppgifter automatiseras vilket minskar risken för såväl avsiktliga som oavsiktliga sekretessbrott. Om vissa personuppgifter kan döljas innebär det dessutom en än större säkerhet för patienterna. Tekniskt sett finns det alltså många bra lösningar som kan förbättra sekretessen, men mycket av detta är dock endast en efterkontroll över att lagar och regler följs, till exempel sparade uppgifter om vad som har hänt en specifik faktura. Det största hotet mot sekretess är dock den så kallade mänskliga faktorn. Det går inte att bygga ett informationssystem så att det inte finns den minsta risk för läckor, eftersom det alltid är de personer som hanterar de känsliga uppgifterna som gör att tanken blir till handling. Vissa typer av misstag eller slarv kan förebyggas med teknik, men personalens inställning till sitt eget arbete och det ansvar som det innebär är en grundläggande faktor såväl med pappers- som e-fakturor. / This thesis deals with integrity sensitive healthcare information on invoices, a subject that arose during my work at county council secretariat in Jönköping. When a person gets treatment in another county than the home county the invoice are sent to the home county, but before these invoices are paid, they have to be checked and attested. This handling was experienced as time consuming and ineffective which led me in to some thoughts around electronic billing (e-billing). The invoice contains integrity sensitive information, like personal code numbers and other kind of information, which is possible to connect with diagnosis and treatments. Therefore it is important that the handling becomes effective and that the secrecy can be maintained during the whole billing process. In this study I discuss how the handling of integrity sensitive healthcare information is influenced if the invoice handling is digitalised. The purpose was to do a comparison the handling of secrecy between paper invoices and digital e-billing. The study was accomplished by a qualitative approach where one organisation, Jönköpings county council, was examined more thorough and for the data collection literature studies and interviews were chosen. The result showed that the secrecy around paper invoices is a sensitive factor. It is not able to trace the handlings around these documents and an invoice could easily disappear within an organisation. On the contrary, for e-bills there is a large possibility to trace and control the handlings. There are different kinds of e-billing and if a system like for example EDI-billing is chosen, a lot of tasks could be automatized. That will decrease the risk for intentional as well as unintentional secrecy crimes. Furthermore, if some personal information could be hidden, it would mean a better safety for the patients. Technically there are a lot of good solutions that is able to improve the secrecy, but a lot of these are only a recheck that laws and rules are followed, for example saved information about what have happened with a specific invoice. The biggest threat though is the so called human element. It is impossible to build an information system that contains no leaks, because it is always the persons that are handling the delicate information that makes the thoughts into actions. Some kind of mistakes or carelessness could be prevented by technical solutions, but the staffs’ attitude of their work and the responsibility is a fundamental factor with papers- as well as e-bills.

This study was performed in Eskilstuna, Sweden in the spring of 2011. The Sörmland CountyCouncil (SCC) initiated the study to improve the communication with the public by adjustingthe language on its website. The website is an important communicative tool since manypeople search for health care information online. Thirty-six terms on the website of the SCCwere the objects of study, a majority of them being names of the departments atMälarsjukhuset Hospital. The departments are presented as a list of links on the website. Fouradditional medical terms were included. The comprehension of the 36 terms was investigatedamong 210 health care centre visitors in Eskilstuna. A questionnaire was used where theinformants were asked to shortly explain what health care issues are dealt with in the differentdepartments. The understanding varied greatly among the terms, from Klinisk fysiologi ochnukleärmedicin (clinical physiology and nuclear medicine/Clinical physics and nuclearmedicine) which only 14.6% of the informants understood to Ögon (eyes/Ophthalmology)which was understood by 92.98%. Seven of the terms were understood by less than 50% ofthe informants. The recommendation of the study to the SCC was to replace terms that werehard to understand to direct the website visitors to the information they are looking for andalso to review the language in all written communication with this study in mind.

The aim with this independent degree project of master thesis is to find what the user opinions of the intranet in a county council is. The paper seeks how the question about how the culture in the organisation was affected by the use of the intranet. An important part is to explore the expectations and acceptance of the intranet and get a picture of which functions and services support day-to-day work with good quality. One goal is to find out how the intranet users feel that the communication, information and usability can be developed. The focus group interview is a qualitative method that has been applied for gathering data from the respondents, who participate in the investigation from the county council. The used method is unstructured focus groups containing the three dominating categories of staff in the county council. Totally five focus groups have been interviewed. In the result and the following analysis of data from the focus group interviews have a few main categories been chosen for the survey. One of the categories is the information- and communication flows in the intranet, which include how it works today and could be improved. Other parts in the analysis are usability, organisation culture and the potential for the intranet as a tool for the organisation. A number of conclusions are drawn from the survey and the analysis. One conclusion is that the intranet is a well-accepted channel for information, but underestimated as a communication channel. Another conclusion is that the respondents considered that an intranet has to be fun, exciting, and contain interesting material; which will lead to that the intranet will be used more. The content has to be updated and suited for the needs of the organisation.

Varje år drabbas tusentals patienter av skador inom vården på grund av felbehandlingar, stress och brister i kommunikation mellan vårdpersonal. Utöver detta dör över tusen patienter varje år till följd av vårdskador. Som en jämförelse kan nämnas att det är fler personer än vad som exempelvis dör i trafikolyckor. Arbetet med patientsäkerhet är därför ett mycket viktigt område. För att identifiera risker och tillbud är rapportering och utredning av avvikelser ett viktigt verktyg och för detta används digitala avvikelsesystem. Då det är tidigare känt att hälso- och sjukvården är en sektor som upplevt utmaningar inom digitala system ses behovet att undersöka vad den generella uppfattningen är kring de avvikelsesystem som används av Sveriges landsting. Specifikt syftar denna studie att undersöka uppfattningar kring användbarheten i dessa system och vart eventuella utmaningar ses. Genom resultatet kan det konstateras att det finns stora skillnader kring de generella uppfattningarna om avvikelsesystemen. Gällande de generella uppfattningarna om användbarheten i avvikelsesystemet ses mindre variationer och hos en tydlig majoritet av landstingen ses en negativ uppfattning. Dock krävs en fördjupad studie för säkerhet i resultatet. Specifika användbarhetsutmaningar har uppmärksammats på den nivå i systemet som hanterar och utreder avvikelser. En ytterligare utmaning tyder på att majoriteten av avvikelsesystemen är för komplexa i förhållande till verksamhetens behov vilket kan innebära en negativ påverkan på användbarheten i avvikelsesystemet. Sammanfattningsvis ger därför denna studie stöd för att vidare forskning kring användbarhetsaspekter inom avvikelsesystem kan vara av värde för hälso- och sjukvårdens avvikelsehanteringsprocesser och lärande. / Every year, thousands of patients suffer from injuries due to medical errors, a stressed working environment and miscommunication between health care professionals. In addition, over a thousand patients die each year due to medical injuries. As a comparison, this number is higher than, for example, deaths caused by traffic accidents. Therefore, the work on patient safety is a very important area. In order to identify risks and incidents, reporting and investigation of incidents is an important tool, and for this digital Incident Reporting Systems are used. Knowing that health care is a sector that has previously experienced challenges within digital systems this motivates a need to investigate general perceptions and challenges in Incident Reporting Systems used by Swedish County Councils. In particular, this study aims to investigate the perceptions of the usability in these systems and where potential challenges are seen. With support from the results, it can be concluded that there are significant differences on the general perceptions of the Incident Reporting Systems. In regards to the general perceptions on the usability in the Incident Reporting Systems less variation is seen, and by a clear majority of the County Councils a negative perception is seen. Although, an additional in-depth study is needed to attain reliability in the results. Specific usability challenges have been recognised at the advanced user level who are handling and investigating the reported incidents. Another challenge suggests that the majority of the Incident Reporting Systems are too complex in relation to the needs of the business which may have a negative impact on the usability of the Incident Reporting System. To summarize, this study supports that further research on the usability aspects of Incident Reporting Systems can be of value to health care’s incident reporting processes and learning.