Background In Sweden, 20% of female patients have reported lifetime experiences of abuse in any health care setting. Corresponding prevalence among male patients is estimated to be 8%. Many patients report that they currently suffer from these experiences. Few empirical studies have been conducted to understand what contributes to the occurrence of abuse in health care. Objectives To understand what factors contribute to female patients’ experiences of abuse in health care. Design Constructivist grounded theory approach. Settings Women's clinic at a county hospital in the south of Sweden. Participants Twelve female patients who all had reported experiences of abuse in health care in an earlier questionnaire study. Methods In-depth interviews. Results The analysis resulted in the core category, the patient loses power struggles, building on four categories: the patient's vulnerability, the patient's competence, staff's use of domination techniques, and structural limitations. Participants described how their sensitivity and dependency could make them vulnerable to staff's domination techniques. The participants’ claim for power and the protection of their autonomy, through their competence as patients, could catalyze power struggles. Conclusions Central to the participants’ stories was that their experiences of abuse in health care were preceded by lost power struggles, mainly through staff's use of domination techniques. For staff it could be important to become aware of the existence and consequences of such domination techniques. The results indicate a need for a clinical climate in which patients are allowed to use their competence. / <p>Funding Agencies|Swedish Research Council|2009-2380|</p>

The aim of this study was to describe peripheral vascular patients´experiences of quality of care in connection whith ambulatory care, and to identify if ambulatory treatment responded to patients´expectations. / Syftet med studien var att beskriva perifert kärlsjuka patienters erfarenheter av vårdkvalitet i samband med dagkirurgisk vård och identifiera om dagkirurgisk behandling motsvarade patienters förväntningar. Detta mättes med hjälp av frågeformuläret Kvalitet Ur Patientens Perspektiv - KUPP. Designen var en beskrivande empirisk studie med kvantitativ ansats. Patienterna valdes konsekutivt och bestod av 47 respondenter (22 män och 25 kvinnor). Samtliga patienter vårdades elektivt där intentionen varit dagsjukvård. Resultatet visade att patienterna generellt varit nöjda med vårdkvaliteten. Balans eller övergod kvalitet skattades på frågor inom dimensionen fysiskt - tekniska förutsättningar och inom dimensionen kontextspecifik där påståenden om dagsjukvård besvarats. Vårdkvaliteten bedömdes även hög vad gäller medicinsk vård och väntetid, läkarens och sjuksköterskans engagemang och visad respekt och att patienterna fått tillräcklig information om själva ingreppet före behandlingen. Brister identifierades vad gäller patienternas erfarenheter av information om resultatet efter behandling. På frågor som berörde läkares och sjukaköterskors empatieka kvaliteter bedömdes vårdkvaliteten vara hög men på andra frågor inom dimensionen identitetsorienterat förhållningssätt bedömdes vårdkvaliteten bristande. detta gällde frågor som berörde information om ansvarig person, delaktighet och information/undervisning i egenvård. Slutsatsen blev att patienterna generellt var nöjda med vårdkvaliteten men att det fanns frågor där kvalitetsförbättrande åtgärder bör ges prioritet.

Based on the 2011 annual report of the United States Renal Data Library System (the USRDS), the prevalence and incidence of dialysis patient in Taiwan were the first and second in the world and the population of dialysis patient has exceeded six million (65883). Where can provide dialysis medical services called the hemodialysis center. According to the setting standards of medical institutions,provisions of the Department of Health, hemodialysis center can be set by the hospitals under the division of of Nephrology (Medical Center, regional teaching hospital, district hospital) and also set by the specialised clinics, hemodialysis centers will attached to the hospital or the clinic. Taiwan have 571 hemodialysis centers where can provide dialysis medical services , separated to 262 hospitals and 309 clinics. We want to study the difference of quality of health care services provided by these two center categories ? Is it different from their patient satisfaction and patient behavioral intention ? Whether their own merits, can each play? This study is based by the 5Qs the model proposed by Zineldin (2006) upon the hemodialysis patients, we have chosen four quality dimensions including the quality of object, quality of process, quality of communication and the quality of atmosphere to see which quality of health care services will affect their satisfaction and behavioral intentions, and look forward to the results of a study on the different category of hemodialysis centers in the future to improve the quality ofhealth care services, strengthening the competitiveness and sustainable management, to provide effective strategic direction.The study included patients from the three hemodialysis centers, each centers have received 100 questionnaires (one is regional teaching hospital, one is district hospitals and the rest is nephrologist clinics ). Effective returned questionnaires is 240 and the rate is 80%. In this study, the quality of healthcare services is based on four quality dimensions as the unit of analysis, the patient`s satisfaction, patient`s behavior intension. The results of this study are summarized as follows: 1. Quality of healthcare services " quality of object " and " quality of process ", "quality of atmosphere " has a positive significant impact on patient`s satisfaction, particularly in the " quality of process ",but " quality of interaction " has no significant relationship. The quality of healthcare services, " quality of process " has a positive significant impact on patient behavior intentions, but the " quality of object " ," quality of process " and " quality of interaction " have no significant relationship. 3 Patient`s satisfaction has positive and significant impact to behavioral intentions each other. 4.Different category of hemodialysis centers all have significant correlation for the " quality of object ", " quality of process ", " quality of interaction ", "quality of atmosphere ", patient`s satisfaction and patient`s behavior intention".

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2010.

Syfte: Syftet med litteraturstudien var att beskriva metoder som kan förbättra kommunikationen mellan sjuksköterskor och läkare för en säkrare vård. Syftet var även att beskriva kvalitén på de granskade artiklarna utifrån metodologiska aspekter gällande undersökningsgrupp och datainsamlingsmetod. Metod: En deskriptiv litteraturstudie baserad på 15 vetenskapliga artiklar. Data samlades in ifrån databaserna PubMed och Cinahl samt via manuell sökning. Artiklarna granskades samt analyserades och resultatet presenterades utifrån tre teman. Resultat: Olika metoder förbättrade kommunikationen mellan sjuksköterskor och läkare. Förbättrad kommunikation och förbättrade attityder till samarbete har visats efter att professionerna fått utbildning inom området kommunikation. Utbildning i kommunikation och kommunikationsverktyg gav struktur i kommunikationen och sjuksköterskorna upplevde att kommunikationen med läkarna förbättrades med en känsla av trygghet och mindre stress. Omstrukturering i arbetet och personalgruppen resulterade i ett starkare vårdteam med minskad hierarki och en förbättrad kommunikation. Flera metoder upplevdes av sjuksköterskorna ge en förbättrad vård för patienterna. Slutsats: Utbildning i kommunikation och kommunikationsverktyg samt omstrukturering i arbetet förbättrar kommunikationen mellan sjuksköterskor och läkare. Metoderna förbättrar samarbetet, tonar ned hierarkin och bidrar till en säkrare vård. / Aim: The aim of the literature study was to describe methods that can improve the communication between nurses and physicians for a safer care. The aim was also to describe the quality of the reviewed articles based on methodological aspects concerning the study group and the data collection method. Method: A descriptive literature study, based on 15 scientific articles. The data was collected from the databases PubMed and Cinahl and through manual search. The articles was reviewed and analyzed and the results were presented in three themes.Results: Different methods improved the communication between nurses and physicians. After studying communication and collaboration they´ve seen improved communication and attitudes towards communication. Education in communication and communication tools provided the structure of the communication and the nurses felt that communication with physicians improved with a sense of security and less stress. Restructuring of work assignments and the staff resulted in a stronger health care team with less hierarchy and improved communication. Several methods were experienced by the nurses to improved care for the patients. Conclusion: Education in communication, communications tools and reconstruction of job assignments improved communication between nurses and physicians. The methods improve the collaboration, it became less hierarchy and contribute to a safer care.

ackground. There are a number studies related to patients’ satisfaction with health care. Since the Baltic States regained independence in 1990, a reform of the health care system took place in which a serious consideration is paid to health care quality. Patients' views are becoming increasingly important in the current health system. They provide information on effectiveness of healthcare and how it may be improved.The main objective of this study was to investigate inpatients experiences with the care and treatment given in Klaipeda hospitals in order to improve the quality of care and patients’ satisfaction. Material and methods. A cross-sectional survey with questionnaires was made. The subjects of the investigation were patients (from 18 years old), hospitalized in internal and surgery departments in different Klaipeda city hospitals. The survey questions were divided into sections that broadly followed the patient's experience in the hospital. The analyses included descriptive statistics, interrelationship analysis between the different characteristics, and multiple logistic regression to estimate Odds for each of the independent variables in the model.Results. The study shows that 60-80 % of the respondents were satisfied with different parts and aspects of health care services. Satisfaction with getting enough time for discussion with the doctor was higher for younger, male and employed patients. Those from the city needed more understandable explanation from doctor about health condition or treatment plan. Doctors listened more to male patients compare to female. Those results were statistically significant. Conclusions. Majority of the patients were satisfied with hospitalization order in Klaipeda hospitals. Better physician communication skills can improve patient satisfaction and clinical outcomes. Physicians could more effectively facilitate patient involvement by more frequently using partnership-building and supportive communication. Hospital cleanliness is quite important factor to overall satisfaction with hospital care. Waiting time is a significant component of patient satisfaction and depends from patients’ characteristics and their behavior. Different aspects of reception can influence patients’ satisfaction and must be considered. Information about continuity of the treatment were needed more for patients with an increased need for follow up, younger and living alone patients. It is important to provide the setting customers expect and create an environment that meets or exceeds customer needs for safety, security, support, competence, physical comfort, and psychological comfort. / <p>ISBN 91-7997-146-6</p>

Bakgrund: En pågående trend inom hälso- och sjukvården är införandet av marknadsreformer. Den lag som ska tillämpas när ett vårdvalssystem införs är lagen om valfrihetssystem (LOV). På grund av att landstingen är självstyrande kan formerna för organisation och styrning variera. Syfte: Att undersöka och beskriva hur landsting praktiskt arbetar med att följa upp privata vårdgivare inom primärvården, med avseende på kvalitet i vården. Metod: Deskriptiv fallstudie med triangulering. Resultat: I alla de tre fallen framhålls att uppföljningen av de offentliga och privata vårdcentralerna är likadan. Det görs uppföljning av samtliga vårdcentraler en gång per år. Till denna samlas data in från olika källor. Stockholm och Sörmland gör även månadsvis mätningar av några indikatorer. Vilka indikatorer som används till uppföljningarna skiljer sig något mellan de olika landstingen. Om avvikelser upptäcks vidtas olika former av åtgärder, exempelvis utskick av skriftliga frågor eller möten där avvikelsen, eventuella orsaker samt vad som ska göras diskuteras. Andra åtgärder kan vara besök hos vårdgivaren, fördjupad granskning eller medicinsk revision. I landstingens förfrågningsunderlag finns beskrivet vad som följs upp. Vissa indikatorer kopplas till målrelaterad ersättning, viten eller bonus. Det framgår även under vilka förutsättningar ett avtal skulle kunna sägas upp i förtid. Förtida uppsägning baserat på kvalitetsskäl har endast skett i Stockholm. Exempel på ett område där samtliga landsting har pågående utvecklingsarbete är utformning av kvalitetsindikatorerna. Samarbeten sker med andra landsting i olika nätverk för utveckling av uppföljningsarbetet. Exempel på svårigheter som ses är att kvaliteten på data som rapporteras in kan brista, tillgång till olika datasystem samt att mäta och fråga rätt saker. Slutsats: Det finns likheter i hur landstingen har utformat sina uppföljningsverksamheter men också skillnader, exempelvis att Stockholm rutinmässigt gör uppföljningsbesök hos nystartade enheter och att Uppsala gör en generell fördjupad uppföljning. / Background: An ongoing trend in health care is the implementation of market reforms. The applicable law when implementing a system of choice is lagen om valfrihetssystem (LOV). Because of the fact that the county councils have home rule the forms of organization and governance can vary. Aim: To study and describe how county councils work with following up private actors in primary care, with regard to quality. Method: Descriptive case study with triangulation. Results: In all three cases it is stressed that the follow up is the same for private and public district health care centres. A follow up of each centre is carried out annualy. For this data is collected from different sources. Stockholm and Sörmland also measure some indicators monthly. Which indicators that are used in the follow ups differ somewhat between the county councils. If deviations are detected different steps are taken, for instance written questions or meetings where the deviation, possible causes and interventions are discussed. Other steps could be to visit the actor, have an intensed review or medical revision. The county councils’ rule books describe what is included in the follow ups. Some indicators are connected to a goal related payment, fine or bonus. It is also stated under what circumstances a contract could be terminaded prematurely. Premature termination based on quality reasons has only occurred in Stockholm. An example of an area where all county councils have an ongoing developement is formation of the quality indicators. There are cooperations with other county councils in different networks regarding development of the follow ups. Difficulties that have been noted are for example that the quality of data that is reported in might be lacking, access to different computer systems and measuring the correct things. Conclusion: There are similarities between the county councils with regard to how they have chosen to design their follow up work, but there are also differences, for instance that Stockholm routinely makes follow up visits to newly started units and that Uppsala does a general intensed review.

The implementation of Electronic Medical Records (EMRs) may lead to improved quality of primary health care. To investigate this, we conducted a mixed methods study of eighteen Toronto family physicians who implemented EMRs in 2006 and nine comparison family physicians who continued to use paper records. We used a controlled before-after design and two focus groups. We examined five preventive services with Pay for Performance incentives: Pap smears, screening mammograms, fecal occult blood testing, influenza vaccinations and childhood vaccinations. There was no difference between the two groups: after adjustment, combined preventive services for the EMR group increased by 0.7% less than for the non-EMR group (p=0.55, 95% CI -2.8, 3.9). Physicians felt that EMR implementation was challenging.

The implementation of Electronic Medical Records (EMRs) may lead to improved quality of primary health care. To investigate this, we conducted a mixed methods study of eighteen Toronto family physicians who implemented EMRs in 2006 and nine comparison family physicians who continued to use paper records. We used a controlled before-after design and two focus groups. We examined five preventive services with Pay for Performance incentives: Pap smears, screening mammograms, fecal occult blood testing, influenza vaccinations and childhood vaccinations. There was no difference between the two groups: after adjustment, combined preventive services for the EMR group increased by 0.7% less than for the non-EMR group (p=0.55, 95% CI -2.8, 3.9). Physicians felt that EMR implementation was challenging.

Syfte: Studiens syfte var att undersöka vad patienterna har för upplevelser av sjukvården, samt vilka förbättringar de föreslår. Metod: Undersökningsgruppen bestod av 50 patienter som svarat på de öppna frågorna i en nationell patientenkät. Svaren analyserades med kvalitativ innehållsanalys. Resultat: Analysen av materialet resulterade i fem kategorier och elva underkategorier. De fem kategorierna bestod av: bemötande, sjukhusmaten, vårdmiljön under sjukhusvistelsen, in- och utskrivning samt väntetider under vårdtiden och samarbete mellan professioner. Patienter som vårdades inom slutenvården ansåg att det bemötande de erhöll i huvudsak varit gott, men att det förekom vissa negativa attityder som bör förändras till det bättre. Förbättringar av måltider och sjukhusmiljön önskades, dessa områden upplevdes otillfredsställande. Vidare föreslogs förbättringar rörande information och kommunikation. Dessa två faktorer spelade, enligt patienter, roll för hur trygga de kände sig inom vården. Väntetiderna upplevdes vara alltför långa och patienterna önskade att dessa ska bli kortare. Slutsats: Patienterna i denna studie hade både positiva och negativa upplevelser av slutenvården, samt föreslog förbättringar på ett antal områden. Detta resultat, samt framtida patientundersökningar, kan vara ett underlag för sjuksköterskors kvalitetsförbättringsarbete i den kliniska verksamheten då det identifierar områden i behov av förbättring. / Aim: The aim of this study was to examine patients’ experiences of health care, and which improvements they propose. Method: The study group consisted of 50 patients who answered the open-ended questions in a national patient satisfaction questionnaire. The patients’ answers were analyzed with qualitative content analysis. Results: The analysis resulted in five categories and eleven subcategories. The five categories were:  social interaction with staff, hospital food, hospital environment during the stay, admission, discharge and delays and collaboration with other professions. Patients who received hospital care generally considered themselves treated well by staff, but some experienced negative attitudes from staff which leaves room for improvement. Other areas considered dissatisfying were the hospital food and the hospital environment. Furthermore, suggestions were made concerning the improvement of information and communication. These factors, according to patients, affect whether they feels safe or not when receiving health care. Patients also expressed that waiting times and delays were too long, and ought to be shortened. Conclusion: Patients in this study had both positive and negative experiences of their hospital stay. They suggest improvements in several areas. These results, together with future patient satisfaction surveys, can develop a basis for nurses to improve the quality of care in clinical practice since they identify areas in need of improvement.