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Some innovations are termed ‘disruptive’, a designation that is normally applied to technology; examples include computers, digital cameras, and mobile phones. The term can also be applied to groups of workers, particularly if they are able to offer specific technical capabilities within a market at lower cost, but broadly equal and effective to that offered by traditional products or services. Paramedics could be described in this way and are a newly professionalised group, with distinctive capabilities in terms of responding to the needs of not just the acutely ill and injured, but increasingly those patients with undifferentiated non-life- threatening conditions, which increasingly make up the bulk of 999 call demand. The key to their transition from an artisan, skilled worker to professional status is the acquisition of certain ‘hallmarks’. Perhaps the most important of these is the completion of more prolonged education that affords the opportunity to graduate with enhanced decision-making and other clinical skills in order to meet the needs of the full spectrum of patients in the pre-hospital setting. Paramedics were surveyed to determine how they rated their ‘traditional’ preparation and to establish what their attitudes were to a more educationally based approach. Paramedics themselves proved to be realistic regarding shortcomings in established training and education systems, while also being strongly motivated to learn more within a higher education setting, particularly if this additional effort would result in being able to offer a wider range of care to their patients. During the study, major changes in the health care environment and the role of the Ambulance Service took place, leading to a requirement to undertake a second phase of research. This took the form of ‘Horizon Scanning’ in an attempt to detect ‘signals’, themes and trends in relation to newly emerging ‘competitors’ to the paramedic role. These included nursing, new practitioners and most critically, the rapidly emerging medical sub-speciality of pre-hospital care, staffed by medical personnel on a pattern found specifically in some European countries, sometimes termed the ‘Franco-German’ model/System (FGM/S). Hitherto, the model of provision in the UK had followed the ‘Anglo-American’ model/System (AAM/S), approach, with paramedics providing direct patient care in the field and medical staff largely involved in medical oversight, teaching, clinical governance and other higher level roles. As part of this research, the evidence base for change was examined and consideration given to the factors that might help clarify what the likely situation could be in 2030 in respect of ambulance services, pre-hospital care and paramedics. This future is uncertain, but factors have been identified that would militate in favour of one or other model prevailing, with close links established between educational preparation, system design, career structure and the continuance of the professionalisation process favouring paramedic progression. However, other factors, most specifically professional power, the absence of a clear evidence base and an apparent reluctance to clearly acknowledge this in some respects, lead to the conclusion that the future of pre-hospital care remains uncertain and contested, but also potentially amenable to a well-directed influencing strategy.

Introduktion: Omvärldsbevakning/analys är ett förekommande krav för organisationer som ett led i att tidigt identifiera omvärldens påverkan på den egna organisationen samt som underlagför att kunna fatta gynnsamma beslut. Det finns ingen allmängiltig definition eller vedertagen metod när det gäller omvärldsbevakning/analys i offentlig verksamhet. Omvärldsbevakning/analys utgör en komponent i det svenska krisberedskapssystemet och ett värde finns i att förstå arbetsprocessen och de faktorer som påverkar tillvägagångssättet. En viktig utgångspunkt för samhällets säkerhet och krisberedskap är risk – och sårbarhetsanalyser (RSA). En RSA är tänkt att utgöra grunden i arbetet med att identifiera hot och risker, minska sårbarheter och öka förmågan att förebygga, motstå och hantera kriser och extraordinära händelser. Samhällets snabba förändring, gör att potentiella risker och hot kan vara svåra att förutse. Att samhället dessutom i ökande omfattning bestå av komplexa beroendeförhållanden ökar utmaningen ytterligare. En del i arbete med RSA innebär att studera hur omvärlden påverkar eller möjligen kan påverka den egna verksamheten samt identifiera hot, vilket innebär att verksamheten behöver utöva någon form av kontinuerlig omvärldsbevakning. Genom att titta på processer med nära koppling till omvärldsbevakning/analys kan begreppen sättas i förhållande till samhällsviktig verksamhet och utveckla arbetet i dessa verksamheter.  Syfte: Utgångspunkten för studien är att beskriva regioners arbete med RSA utifrån delkomponenterna i verksamhetsteorin samt utifrån verksamhetsteorins olika perspektiv. Att använda verksamhetsteorin som en teoretisk ram innebär ett försök att spegla de faktorer som påverkar arbetet utifrån ett holistiskt perspektiv genom att belysa faktorer utifrån det teoretiska ramverkets olika delar. Studiens syfte är att därigenom få en förståelse för de faktorer som utgör hinder och skapar goda förutsättningar för arbetet med RSA och hur dessa faktorer samspelar med varandra. Dessutom syftar studien till att få en ökad förståelse för hur omvärldsbevakning och/eller omvärldsanalys nyttjas i arbetet med RSA.   Metod: Metoden baseras på semi-strukturerade intervjuer och genomförs med en deduktiv ansats. Resultat: Studiens resultat presenteras i förutbestämda teman utifrån verksamhetsteorins aktivitetssystem; Aktör, Verktyg, Regler, Gemenskap, Arbets- och ansvarsfördelning, Mål och Utfall.   Slutsatser: Hur arbete med RSA organiseras skiljer sig mellan regioner. En enighet som ses är att RSA främst syftar till att uppfylla egennyttan för regionen, i andra hand för att uppfylla lagkravet. De delkomponenter utifrån verksamhetsteorin som ses ha en betydande roll för arbetet med RSA är arbets- och ansvarsfördelning samt gemenskap. Dessa delkomponenter verkar framför allt utgöra de delkomponenter i verksamhetsteorins aktivitetssystem som påverkar förutsättningarna för samverkan, som anses utgöra den viktigaste faktorn för ett framgångsrikt arbete med RSA. Omvärldsbevakning/analys görs regelbundet som en del i medarbetares arbetsuppgifter. I det specifika arbetet med RSA verkar det utföras omvärldsbevakning/analys inom samtliga delar av processen genom samverkan. / Introduction: Horizon scanning is a common requirement for organizations as a part of the work to better anticipate future opportunities or threats and to identify issues in the present that are of major importance for the organisation. There is no clear definition or established method for horizon scanning in the public sector. Horizon scanning is a component of the Swedish crisis preparedness system and there is value in understanding the work and the factors influencing the approach. An important part of the crisis preparedness system involves risk- and vulnerability analysis (RVA). RVA is intended to form the basis for identifying threats and risks, reducing vulnerabilities and enhancing the capacity to prevent, withstand, and manage crises and extraordinary events. The rapid changes in society makes it difficult to predict potential risks and threats. In addition, the increasing complexity of interdependencies in society further aggravate the challenge. As a part of an RVA, studying how the external environment influences or may influence the organization's activities and identifying threats requires the organization to engage in some form of continuous horizon scanning. By examining processes closely related to horizon scanning, the concept can be related to vital societal functions and critical infrastructure and thereby develop work within these areas.  Purpose: The study aims to describe how county council conduct RVA based on the activity theory and the different perspectives within the theory. Using activity theory as a theoretical framework attempts to reflect key areas influencing the work from a holistic perspective. The purpose of the study is thus to gain an understanding of the areas influencing the work of RVA and how these interact with each other. Additionally, the study aims to enhance understanding of how horizon scanning is utilized in the work of RVA. Method: The method is based on semi-structured interviews conducted with a deductive approach.  Results: The result of the study's are presented in predetermined themes based on the activity system: Actor, Tools, Rules, Community, Division of Labor, Goals and Outcomes.  Conclusions: How county council conduct RVA differs. A common agreement is that RVA primarily serves the county council´s own interests, and compliance with legal requirements is secondary. The areas of activity theory that appear to have a significant role in the work of RVA are Division of labor and Community. These areas primarily seems to affect the conditions for collaboration, which is considered to be the most crucial factor to succeed in the work. Horizon scanning is performed regularly as part of employees' everyday tasks. In the work of RVA horizon scannning is performed within the different parts of the process, primarily throu collaboration.

Made available in DSpace on 2011-05-04T12:36:28Z (GMT). No. of bitstreams: 0 Previous issue date: 2009 / As atividades de rastreamento do horizonte tecnológico, uma forma de avaliação de tecnologia em saúde realizada no início do ciclo de vida das tecnologias, vêm sendo difundidas em países desenvolvidos desde a década de 90, visando tornar mais eficientes os processos de tomada de decisão relativos à incorporação de novas tecnologias. Trata-se de uma abordagem sistemática para a identificação e avaliação de tecnologias novas / emergentes, com o objetivo de alertar os tomadores de decisão quanto à sua existência e potenciais conseqüências de sua incorporação para o sistemade saúde, antes da difusão do seu uso. Considerando a relevância de operacionalizar as atividades de rastreamento do horizonte tecnológico para a atenção à saúde no Brasil, apresente dissertação teve o objetivo de produzir subsídios para a elaboração de diretrizes de um sistema de rastreamento do horizonte a ser criado no País. Para auxiliar o processo de elaboração, foi realizado um exercício de rastreamento do horizonte, no qual foi utilizado o caso das tecnologias envolvidas no manejo da osteoporose em mulheres na pós-menopausa, um problema de saúde considerado relevante, para o qual não existe solução razoável. Inicialmente, procedemos a uma revisão do conceito e das experiências internacionais com sistemas de rastreamento do horizonte tecnológico (SRH) em saúde. As fontes consultadas e os trabalhos analisados indicam um consenso de que um SRH deve sempre basear seu trabalho na melhor evidência preliminar disponível sobre o efeito das tecnologias, na saúde das pessoas e sobre o sistema de saúde, e atuar de maneira transparente, explicitando ao máximo a metodologia adotada no processo de trabalho. A revisão também permitiu a identificação de muitos desafios e pontos críticos para o desenvolvimento e operacionalização de tal sistema. O exercício de rastreamento realizado possibilitou a identificação de uma nova tecnologia medicamentosa, o denosumab, para o tratamentoda osteoporose, cujos ensaios clínicos de fase II e III, recentemente publicados, foram analisados. As limitações enfrentadas na realização do exercício permitiram reconhecer algumas dificuldades básicas específicas da avaliação tecnológica no início do ciclo devida. A avaliação das experiências internacionais e o exercício acima referido indicam que, para o desenvolvimento e operacionalização de um SRH no Brasil, o intercâmbio e a colaboração institucional com as unidades governamentais de monitoramento do horizonte de países desenvolvidos será fundamental, tendo em vista o corpo qualificado e a longa experiência daquelas unidades nessas atividades e, ainda, a quantidade de trabalho e de tempo envolvidos na análise de cada tecnologia e a urgência inerente a essas atividades. Além disso, deverá haver uma articulação entre os atores-chave, especialmente os do âmbito governamental, com o objetivo de discutir e estabelecer as diretrizes para a criação do sistema. Com isso, espera-se que as informações produzidas pelo SRH brasileiro sejam adequadamente utilizadas no processo de tomada de decisão do sistema de saúde. / Activities related to horizon scanning of technologies for health care, a form of health technology assessment carried out at the beginning of the life cycle of those technologies, have been adopted in several developed countries since the 90s, with the purpose of improving the efficiency of decision making related to the incorporation of new technologies. Horizon scanning consists of a systematic approach to identify and assess new and emerging technologies in order to warn health care decision makers about the existence and potential consequences of their incorporation to individuals and to the health system, before the diffusion stage. Given the importance of developing horizon scanning activities for health care technologies in Brazil, the present work had the objective of producing subsidies for the elaboration of guidelines to develop a horizon scanning system in Brazil. To aid that elaboration process, the case of technologies designed for the secondary prevention of osteoporotic fractures after menopause, a relevant public health problem far from being solved, was analyzed. Initially, a review of the concept of horizon scanning in health care and of the related international governmental experiences was carried out. The available sources and studies indicate a consensus on that: a) recommendations made by a horizon scanning 8 system must be supported by the best available early scientific evidence of the consequences on the health of the individuals and on the health system of the adoption of new/emerging technologies; b) the horizon scanning system must act in a transparent way, making explicit the criteria and methodology it uses. The review also showed that there remain several challenges to be dealt with in order to further develop such monitoring system. The horizon scanning exercise related to the secondary prevention of osteoporotic fractures enabled the identification of a new drug, called denosumab; phase II and phase III trials of that technology have been recently published and were analyzed. Limitations faced in such exercise made it possible the identification of some specific difficulties associated to technology assessment at the beginning of the life cycle. The review of the international experiences with horizon scanning of health care technologies, at central government level, along with the mentioned exercise, indicate that, for developing a horizon scanning system in Brazil, collaboration with developed countries’ units is essential, taking into account the qualified and experienced staff of such units as well as the amount of work and time involved in the analysis of each technology and the inherent urgency of such activities. Finally, key actors, specially those at central government level, must be articulated for the discussion and elaboration of the guidelines towards the creation of such system. In this way, the chances of a successful effort, with an adequate utilization of produced information in the process of decision-making, are increased.