Bakgrund I svensk hälso- och sjukvård skall prioriteringar utgå från de tre principerna i den etiska plattformen. Habiliteringen i Västra Götaland har utvecklat ett beslutstöd för prioriteringar med utgångspunkt från den nationella modellen för öppna prioriteringar vars syfte är att omsätta den etiska plattformen till praktiken.   Syfte Syftet med förbättringsarbetet var att börja använda beslutsstöd vid val av behandlingsmetoder, och hypotesen var att om beslut tas strukturerat ökar förutsättningarna för en mer likvärdig vård. Studiens syfte var att beskriva medarbetarnas upplevelser av förbättringsarbetet.   Metod I det pågående förbättringsarbetet har Nolans förbättringsmodell använts. Studien genomfördes som en deskriptiv kvalitativ studie och fokusgrupper genomfördes i två omgångar med deltagande team.   Resultat Medarbetarna upplever att arbete utifrån prioriteringsriktlinjer är viktigt men är beroende av beslutsstödet utformning och yttre faktorer. Att prioritera blir enklare om åtgärderna på väntelistan är rangordnade. Det går än inte att utläsa att mer likvärdig vård uppnåtts men när medarbetarna får styra över förbättringsarbetet minskar väntetiden från beslut till behandlingsstart.   Slutsatser Nolans förbättringsmodell fungerar vid införande av beslutsstöd för prioritering. Det återstår att se om beslutsstödet bidrar till en mer likvärdig vård. / Background In Swedish health care priorities shall be based on the principles in the ethics platform. Habilitation Services in Västra Götaland has developed a decision support for priorities on basis of the national model of priorities aimed to translate the ethical platform to practice.   Purpose Improvement work aimed to start using decision support in the selection of treatment. The hypothesis was, if decisions are structured increases the prospects of a more equitable care. The purpose was to describe employees’ experiences of improvement work.   Method The ongoing improvement work have used Nolan's model of improvement. The study was conducted as a descriptive qualitative study with focus groups in two rounds.   Results Employees feel that work on the basis of priority guidelines are important, but are dependent on decision support design and external factors. Prioritizing becomes easier if the waiting list are ranked. It is not yet possible to say that a more equitable care has been achieved but when employees get control over the improvement work the waiting time from decision to treatment reduces.   Conclusions Nolan's model of improvement works at the introduction of decision support for priority. It remains to be seen whether decision support contributes to more equitable care.

Over 25 million Americans report limited English proficiency (LEP) since 2013, and this number has been steadily increasing over the past few decades as immigration to the United States continues to climb. Due to the expanding heterogeneity of the population, cultural and language barriers became more common in the healthcare field which led to worse patient outcomes, inappropriately ordering too many or too few tests, and decreased use of preventative services. This necessitated further resources and interventions to better accommodate individuals with LEP. In accordance with Title VI of the 1964 Civil Rights Act which was elaborated further in Executive Order 13166, federal agencies were required to provide language services to people with LEP. As a result, more medical institutions began implementing interpreter services. Despite these measures, there is lower-than-expected physician compliance with utilizing these services and considerable variability in services offered depending on the clinical setting. Not only does this perpetuate and potentiate the health disparities that this population already faces, but it can also negatively impact a patient’s agency as they do not have the proper resources to fully advocate for their health. Hence, it is integral to examine the potential reasons why the current infrastructure for interpreter services is still lacking and what can be done to optimize accessibility. This thesis will explore some of these limitations and then offer potential solutions that both institutions and medical professionals can implement in order to provide equitable care to patients with LEP. / Urban Bioethics

Equitable healthcare is a prerequisite for good living conditions and good health in the population. The Health Care Act states that healthcare in Sweden must be provided on equitable terms, however, inequities in Swedish healthcare are continuously reported. The aim of this thesis was to investigate barriers and facilitators to equitable care from the perspective of healthcare professionals with coordination responsibility. A qualitative study design with an abductive approach was used. Data were collected through semi-structured interviews with six healthcare professionals with coordination responsibility in Region Gävleborg, all of whom are connected to the local knowledge management group within the lifestyle focus area. Analysis of the collected material was performed using thematic analysis. The results show that healthcare professionals with coordination responsibility view politics and management, work cultures, and staffing as important barriers that exist in working with equitable care. Furthermore, the results show that cooperation within the healthcare organization, patient involvement, and knowledge are considered to facilitate the achievement of equitable care. The conclusion is that more knowledge and clearer guidelines are needed in order for healthcare professionals to be able to work more effectively to counter inequities in care.