Advanced home care (ASIH) enables the patient to stay at home rather than to stay hospitalized in connection with severe medical conditions, while simultaneously this Thesis demonstrates that this is in fact not completely unproblematic and without risk. This partly because ASIH proves to be a complex form of care with many different kind of collaterally ongoing care contacts and efforts of care and concern, partly since ASIH concurrently can assume an overview over the treatment process and collaboration or cooperation between several treatment agents from different kinds of organizations and/or operations during all hours. This composes a relatively new heterogenetic and multifaceted context of care which to the professional practice means both new and less known problems within patient safety, which substantially can obstruct and rule out both the completion and the implementation of a safe home care. The Thesis is based upon an exploratory case study of problems within patient safety in correlation with an advanced home care, and where the research study has had its starting position in the professional practice with an interactive and qualitative research approach. The case study houses two part studies which show that the patient safety problems can be related to an intermediary and multi-organizational form of care, rather than an single operation. A command and control view upon the problems of patient safety, which the professional practice faces, show that missions within the frame of the care form ASIH can be regarded as either a complicated and not rarely a complex operation consistent with Alberts &amp; Hayes (2007) and Brehmers (2008a; 2009c) terminology and where the assignments includes dynamic decision tasks. The case study reveals that the patient safety problems which concretely can obstruct and rule out the completion or implementation of the assignments in a safe way, can be considered related to the layout of the description of the assignments and also a lack of operative and tactical command and control level (of the handling and care of patients) in correlation with the different sorts of assignments that prevails – coincidentally as there is no suitable organization (forums of cooperation) and no appropriate IT-resources for the liaisons which effectively manages to promote and support the forms of cooperation that the character of the assignments also needs. The implicit system of conduct which comes forth through the analysis indicates that there is a need of improvement in order to enable effective command and control for a safer care, since the form of the system of conduct according to Brehmer´s (2006a,b; 2007a,b; 2008a,b; 2009c, 2010, 2011) model fails to satisfy the needs set by the function of command and control. The conclusion of the case study is that advanced home care should be regarded as an intermediary and multi-organizational care form which includes dynamic decision tasks and character wise complex operations contemplated per patient, thus demanding substantial command and control resources, a new point of view upon management and new auxiliary means of management in order to maintain a safe care during the implementation. The hypothesis which has been crystallized during the conclusions of the case study is that a more effective control and command and appropriate auxiliary means of command and control in real time, concerning primarily the handling of patients at the time of a change in care form, can improve the conditions of work in the professional practice and also result in more patient time, which consequently can be expected to contribute to concept of “Good care” i.g. cost effective, patient safe and dignified care. / <p>QC 20120525</p>

Sjöräddning i Sverige sker genom samverkan mellan statliga verksamheter, kommuner och frivilligorganisationer för ett gemensamt mål att rädda personer som råkat i sjönöd. Tid är ofta en kritisk faktor i räddningsuppdragen men ett snabbt och oplanerat utryck riskerar samtidigt att sätta räddningsaktörerna själva i farozonen. Utvecklingen av obemannade autonoma farkoster för SAR (eng. Search And Rescue) ses som en lösning på behovet att kunna snabbt skicka hjälp till samt få ögon på incidentplatsen utan att försätta räddningsaktörerna för onödig risk. Nuvarande kommunikationssystem inom svensk sjöräddning kan dock inte hantera annan typ av information än muntlig varav räddningsaktörer endast känner till riktlinjer för hantering av muntlig information. Med ett framtida införande av autonoma farkoster kommer dock fler informationstyper att behöva hanteras i sjöräddningar varav oklarheten om vilka informationstyper autonoma farkoster samlar in och vilka datahanteringskrav som finns är problematiskt. Oklarhet om informationstyperna och deras datahanteringskrav är vidare problematiskt för utvecklingen och implementeringen av autonoma farkoster då risken finns att farkoster och tekniker utvecklas men inte får användas för att de inte är anpassade efter lagkraven på hantering av olika datatyper. I denna studie undersöks därför vilka informationstyper som autonoma farkoster kan samla in vid sjöräddning. Detta för att komma fram till vilka riktlinjer för datahantering som gäller vid sjöräddning med autonoma farkoster. Studien undersöker också vilka informationstyper som är kritiska för en SAR-sjöräddningssamverkan samt vilka informationsdelningsutmaningar som finns i dagens sjöräddning. Studien genomfördes i form av en kvalitativ fallstudie och har tillämpat ett socio-tekniskt systemperspektiv för att bättre se till helheten och besvara frågeställningarna. Resultatet av denna studie visar att autonoma farkoster kan samla in information om sin omgivning, vilket utgör grunden för att skapa en medvetenhet om situationen som är kritiskt för SAR-operationer, och kan även samla in information om sitt eget tillstånd. De lagverk som identifierats utgöra de huvudsakliga restriktionerna är kamerabevakningslagen, lagen för skydd av geografisk information, offentlighets- och sekretesslagen, GDPR och dataskyddslagen. Dessa lagverk innehåller riktlinjer för delning av information och personuppgiftsbehandling i SAR-sjöräddning. Kunskapsbidrag studien har genererat inkluderar bland annat identifiering av datatyper som kan samlas in av autonoma farkoster i en SAR-sjöräddning, och sannolikt andra typer av räddningsinsatser, och delning och hanteringskraven på de datatyperna i räddningsinsatser och därmed kunskap om vilka datatyper som är mest reglerade. Vidare kunskapsbidrag är kunskap om vilka informationstyper som är mest kritiska för SAR-sjöräddningar, och därför bör prioriteras att samlas in och delas, och identifieringen av utmaningar för informationsdelning mellan statliga verksamheter och frivilligorganisationer. / Maritime rescue in Sweden is performed through a cooperation between government agencies, municipalities and non-governmental organisations (NGOs) with the common goal of saving people in distress. Time is often a critical factor in the rescue missions but a fast and unplanned response may at the same time put the rescue workers in danger. The development of unmanned autonomous vehicles for SAR is seen as a solution to the need of being able to quickly sendhelp as well as get eyes on the scene of the incident without exposing the rescue workers for unnecessary risks. However, the current communications systems in Swedish maritime rescue are unable to handle any other type of information except verbal, meaning that rescue workers only know guidelines for handling verbal information. However, with a future implementation of autonomous vehicles, there will be a need to handle more information types in maritime rescue whereas the uncertainty regarding what kind of information autonomous vehicles collect and which data management requirements exist is problematic. The uncertainty about the information types and their data management requirements is also problematic for the development and implementation of autonomous vehicles as there is a risk that vehicles and technologies are developed but not allowed to be used because they are not adapted to the legal requirements on management of the different types of data. Therefore, in this study I examine what information types that autonomous vehicles can collect in a maritime rescue to find out what guidelines for data management that applies during a maritime rescue with autonomous vehicles. The study also examines what kind of information’s are critical for a SAR maritime rescue cooperation as well as what information sharing challenges exist in current maritime rescue. The study was performed as a qualitative case study and has used a socio-technical systems perspective so as to better see the overall picture and answer the research questions. The result shows that autonomous vehicles can collect information about their surroundings, which is the foundation for establishing situation awareness that is critical for SAR-operations, and that they can collect information about their own status. The main laws and regulations that have been identified as constituting the main restrictions are (translated from Swedish) the law of camera surveillance, the law for protection of geographical information, the public access to information and secrecy act, the GDPR and the data protection act. These contains guidelines for sharing information and the processing of personal data in SAR maritime rescue. The knowledge contributions of this study includes among others the identification of datatypes that can be collected by autonomous vehicles in SAR maritime rescue, and probably other types of rescue operations, and the sharing and management requirements on those datatypes in rescue operations and thus knowledge of what datatypes that are the most restricted. Further knowledge contributions is knowledge about which information types that are the most critical for SAR maritime rescue and thus should be prioritised for collection and sharing as well as the identification of challenges for information sharing between government agencies and NGOs.