<p>Aim:The overall aim of this study was to obtain more knowledge on the implementation of health care marketing in Sweden, using Uppsala University Hospital (UUH) as a case study. Additionally, based on the results of this case study, the aim was also to give concrete suggestions on how to enable increased focus on the formulation and implementation of health care marketing management strategies. This gives the study a slightly normative approach and aim, since the line is not drawn at description and analysis but also advocate guidelines for the enabling of market orientation.</p><p>Method: The chosen methodology of the study was qualitative, as the study sought to explore, interpret and gain a deeper knowledge of the research area.  Three different strategies of primary data collection were used; (1) interviews with key hospital managers, (2) a survey sent to all heads of clinical departments (68 departments) and (3) the study of selected UUH internal documents and UUH internal material related to the subject. The massive data was consolidated, reported and analyzed as separate parts and as well as an overview analysis from a health care marketing management theoretical framework.</p><p>Results & Conclusions:The study showed that UUH, despite the fact that they produce an annual revenue from health care services sales of approx 1,5 billion SEK, lacks almost every aspect of the tools and abilities necessary to function on a competitive marketplace. This included a non-marketing based planning process, the absence of a marketing organizational unit, no marketing research abilities etc. There were also facts pointing at severe flaws in the accounting systems, uncertainties of the legality of the current marketing activities and no marketing-stimulating incentive-systems in place. Besides these hard facts, the conservative, non-market oriented, organizational culture was deemed to make an attempted marketing adaption very hard to implement. The interviews provided valuable data for the structure and analysis. The survey had a very low response-rate, which didn´t provide any valuable data per se, but was interpreted to support the analysis of the organizational flaws in regard to marketing orientation. The internal document study also resulted in support of this analysis and increased the validity. Based on the analysis, a suggestion for a “road map” to successfully market-adapt Swedish health care was presented.</p><p>Suggestions for future research:Health care marketing most likely constitute its own area of research which also is specific for Sweden, which gives infinite opportunities for further studies. The implementation of marketing strategies in health care is an area that really needs to be further studied, therefore a suggestion for future research is to try and find out just how to enable implementation of a marketing-orientation in an organization which never had one. Another suggestion for further research could be the study of how economic incentive systems and other means of co-worker stimulation influence the production of health care services.</p><p>Contribution of the thesis:We believe that this study will strengthen the marketing understanding for UUH personnel at both managerial as well as all other organizational levels that are interested in the subject. We also believe that politicians, both locally and nationally, will benefit from practical knowledge regarding health care marketing mechanisms currently in place. Though conducted as a case study at one hospital, we deem that the analysis and suggestions are applicable for many other health care providers acting on the Swedish health care services marketplace, possibly contributing to the development of Swedish health care.</p>

Aim:The overall aim of this study was to obtain more knowledge on the implementation of health care marketing in Sweden, using Uppsala University Hospital (UUH) as a case study. Additionally, based on the results of this case study, the aim was also to give concrete suggestions on how to enable increased focus on the formulation and implementation of health care marketing management strategies. This gives the study a slightly normative approach and aim, since the line is not drawn at description and analysis but also advocate guidelines for the enabling of market orientation. Method: The chosen methodology of the study was qualitative, as the study sought to explore, interpret and gain a deeper knowledge of the research area.  Three different strategies of primary data collection were used; (1) interviews with key hospital managers, (2) a survey sent to all heads of clinical departments (68 departments) and (3) the study of selected UUH internal documents and UUH internal material related to the subject. The massive data was consolidated, reported and analyzed as separate parts and as well as an overview analysis from a health care marketing management theoretical framework. Results &amp; Conclusions:The study showed that UUH, despite the fact that they produce an annual revenue from health care services sales of approx 1,5 billion SEK, lacks almost every aspect of the tools and abilities necessary to function on a competitive marketplace. This included a non-marketing based planning process, the absence of a marketing organizational unit, no marketing research abilities etc. There were also facts pointing at severe flaws in the accounting systems, uncertainties of the legality of the current marketing activities and no marketing-stimulating incentive-systems in place. Besides these hard facts, the conservative, non-market oriented, organizational culture was deemed to make an attempted marketing adaption very hard to implement. The interviews provided valuable data for the structure and analysis. The survey had a very low response-rate, which didn´t provide any valuable data per se, but was interpreted to support the analysis of the organizational flaws in regard to marketing orientation. The internal document study also resulted in support of this analysis and increased the validity. Based on the analysis, a suggestion for a “road map” to successfully market-adapt Swedish health care was presented. Suggestions for future research:Health care marketing most likely constitute its own area of research which also is specific for Sweden, which gives infinite opportunities for further studies. The implementation of marketing strategies in health care is an area that really needs to be further studied, therefore a suggestion for future research is to try and find out just how to enable implementation of a marketing-orientation in an organization which never had one. Another suggestion for further research could be the study of how economic incentive systems and other means of co-worker stimulation influence the production of health care services. Contribution of the thesis:We believe that this study will strengthen the marketing understanding for UUH personnel at both managerial as well as all other organizational levels that are interested in the subject. We also believe that politicians, both locally and nationally, will benefit from practical knowledge regarding health care marketing mechanisms currently in place. Though conducted as a case study at one hospital, we deem that the analysis and suggestions are applicable for many other health care providers acting on the Swedish health care services marketplace, possibly contributing to the development of Swedish health care.

Akademiska sjukhuset är en stor, samhällsviktig verksamhet som har under de senaste tio åren genomgått flertalet ny- och ombyggnationer. Sjukhusområdet är beläget på Uppsalaåsen och befinns inom en primär skyddszon, vilket innebär en komplex geologi och krav på aktsamhet av grundvattnet som nyttjas för Uppsalas vattenförsörjning. Marken har visats innehålla stora lerkörtlar och drastiska skiftningar av jordarter, vilket har lett till en sättningsproblematik vid sjukhusområdet. Region Uppsala planerar flertalet ny- och ombyggnationer vid Akademiska sjukhuset och på grund av den komplicerade markbilden önskas en utredning av geotekniken och hydrogeologin vid området. Fokuset i detta examensarbete har legat på sättningsbenägenhet och grundvattnets trycknivåer. Fyra delområden av sjukhusområdet har pekats ut av Region Uppsala för eventuella framtida byggprojekt. Dessa områden är vid parkeringshus T3, produktionsköket, NOP-komplexet samt ny cyklotronbyggnad. Genomförandet av detta examensarbete har delats in i tre delar; kartläggning av jordlagerföljd, sättningsberäkningar utifrån CRS-försök, samt utredning av grundvattnets trycknivå. Jordlagerföljd har tolkats i GeoSuite med hjälp av 474 sonderingar genomförda av konsultföretaget Bjerking. Sonderingarnas samtliga jordskikt interpolerades och illustrerades som nivåkurvor med hjälp av Topocad. För att utreda jordlagerföljden vid de utvalda områdena skapades åtta tvärsnitt utifrån en 3D-modell konstruerad i Civil 3D. De jordlager som studerats är fyllnadsmaterial, lera, friktionsjord, berg samt markyta. Sättningskapacitet och dess tidsförlopp har beräknats utifrån två CRS-försök och max-, min- och medelvärden av grundvattnets trycknivå under sjukhusområdet har beräknats utifrån 20 års dagliga data från en av Uppsala Vattens mätbrunnar i Stadsträdgården.   Resultaten bekräftar åsens komplexa geologi av varierande lermäktigheter under sjukhusområdet. Det är sannolikt att flertalet byggnationer kräver djupgrundläggning, exempelvis vid parkeringshuset T3 och produktionskökets norra del. De erhållna resultaten visar även knappa lerlager vid andra delområden, vilket innebär mindre sättningsbenägenhet och kräver troligtvis endast ytgrundläggning. De sättningsberäkningar som utförts indikerar att parkeringshuset T3 kommer sjunka 20 till 70 cm efter 158 till 213 år utan grundläggning, något som liknar den pågående sättningen vid byggnaden. Grundvattnets trycknivå har under de senaste 20 åren haft ett medelvärde på + 2,3 m (RH2000) och kommer sannolikt inte fluktuera framåt på grund av den rådande vattendomen. Detta innebär att byggnationer inom vissa delar av sjukhusområdet, exempelvis vid produktionsköket, kommer behöva tillstånd inför byggnation inom den primära skyddszonen, vilket Akademiska sjukhuset är beläget i. Resultaten ger en god överblick över hydrogeologin vid Akademiska sjukhuset och indikerar hur de utpekade områdena bör projekteras med avseende på grundläggning för hållbart och ekonomiskt bygge. Det krävs dock mer underlag, bland annat fler sonderingar och CRS-försök, för att få en ökad komplexitet av sjukhusområdet i avseende på jordlagerföljd och sättningsbenägenhet. / Uppsala University Hospital is a large institution of vital societal function and many new buildings have been constructed and others rebuild during the past ten years. The hospital area is located on Uppsalaåsen and within a primary protection zone, i.e. there is a complex geology and requirements for the protection of the groundwater used for Uppsala’s water supply. The ground contains large sections of clay and has drastic changes in soil types. This has resulted in a subsidence problem within the hospital area. Region Uppsala has several plans regarding upcoming constructions at Uppsala University Hospital and due to the complicated soil situation is an investigation of the geotechnics and hydrogeology within the area sought for. The focus of this master thesis is on subsidence capacity and the ground water’s pressure levels. Four zones within the hospital area have been pointed out by Region Uppsala for potential future construction projects. The zones are at the parking garage T3, production kitchen, NOP-complex and new cyclotron building. The master thesis was divided into three parts; locating the soil layer sequence, calculation of subsidence based on CRS tests and study of the ground water’s pressure level. The soil layer sequence was construed in GeoSuite based on 474 probes conducted by the consultant company Bjerking. The probs respective soil layer was interpolated and illustrated as level curves using Topocad. Eight cross-sections were made within the zones of extra interest and the sections were made from a 3D-model created in Civil 3D. The soil layers examined throughout the master thesis were filling material, clay, granular soil, rock and ground surface. The subsidence capacity and its time were calculated based on two CRS trials and max-, min- and average values of the ground water’s pressure levels under the hospital area was computed based on 20 years of daily data retrieved from a measuring well in Stadsträdgården facilitated by Uppsala Vatten. The results confirm the ridge complex geology consisting of varying depths of clay under the hospital area. Several buildings will probably require deep foundations, e.g. the parking garage T3. The results also show areas of shallow layers of clay indicating lower risk of subsidence and hence will require a shallow foundation. The conducted subsidence calculations indicate that the parking garage T3 will sink 20 to 70 cm after 158 to 213 years if no foundation is implemented, which is in line with the current subsidence occurring at the building. The ground water’s pressure level has had an average value of + 2.3 m (RH2000) during the last 20 years and will probably not fluctuate in the future due to the existing decision on water management. Hence, some buildings within certain parts of the hospital area will require permission prior to construction within the primary zone.  The results establish a valuable overview of the hydrogeology at Uppsala University Hospital and give indications regarding how the foundations in the zones of extra interest should be dimensioned sustainable and economically. However, more data is needed, e.g. additional probes and CRS trials, to gain an increased complexity of the hospital area in respect to soil layer sequences and subsidence tendency.

In 2012, the county of Uppland in Sweden launched a service granting patients online access to their electronic medical record (EMR), including the list of staff who have logged into the record (the “log list”). Patients seem predominantly positive to this service whereas many professionals, physicians specifically, have expressed concerns about, for example, increased risks of threats and violence towards healthcare staff. One year after launch the present study was conducted to examine whether staff whose patients had gained access to online EMRs experienced greater risks of threats and violence, and were exposed to more threats and violence, than those whose patients had not yet gained access. The extent to which professional role, gender, work experience and staff attitudes to the service were important factors was also examined. A total of 174 professionals at Uppsala University Hospital responded to a web survey (35% response rate). 83 represented the emergency department, whose patients had online EMR access, and 91 represented the psychiatric department, whose patients had not. 40% of all participating professionals, emergency physicians and psychiatric staff specifically, believed that risks of threats and violence increase after launch. The results did not, however, support a correlation between patient access to online EMRs and more incidents of threats and violence, and only one respondent reported that patient access had played any significant negative role in relation to an incident. These and other results may prove useful as the online EMR service is now being launched in other Swedish counties as well. / År 2012 infördes inom Uppsala läns landsting en tjänst som ger patienter tillgång till sin journal via nätet, inklusive listan över personal som loggat in i journalen. Patienter har visat sig vara övervägande positiva till tjänsten, medan många vårdgivare, speciellt läkare, har uttryckt farhågor gällandes, till exempel, ökad risk för hot och våld mot vårdpersonal. Ett år efter införandet genomfördes denna enkätstudie med syfte att undersöka om sjukvårdspersonal vars patienter fått tillgång till journal via nätet upplever högre grad av risk för hot och våld samt om de i realiteten är mer utsatta för hot och våld än dem vars patienter inte fått denna tillgång. Även betydelsen av yrke, kön, arbetserfarenhet samt generell attityd till journal via nätet undersöktes i relation till hot och våldsrisker respektive utsatthet för våld. En webundersökning besvarades av 174 anställda vid Akademiska sjukhuset i Uppsala (svarsfrekvens 35 %). 83 representerade den öppna akutvårdsmottagningen, vars patienter hade tillgång till journal via nätet, och 91 representerade de slutenvårdspsykiatriska avdelningarna, vars patienter inte hade denna tillgång. 40 % av respondenterna, speciellt akutvårdsläkare och psykiatrivårdspersonal, trodde att riskerna för hot och våld ökar vid införande av journal via nätet. Resultaten påvisade dock inte någon korrelation mellan patienttillgång till journal via nätet och förekomst av hot- och våldsincidenter och endast en respondent svarade att patienttillgång spelat en betydande negativ roll i relation till en incident. Dessa och andra resultat i studien kan vara av betydelse nu när införanden av journal via nätet sprids även till andra landsting i Sverige.