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  • 1.
    Hazelzet, Jan A.
    et al.
    Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
    Thor, Johan
    The Jönköping Academy for Improvement of Health and Welfare, School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Andersson Gäre, Boel
    The Jönköping Academy for Improvement of Health and Welfare, School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Kremer, Jan A.M.
    IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.
    van Weert, Nico
    Society Personalized Healthcare, Nijmegen, The Netherlands.
    Savage, Carl
    Medical Management Centre, Department of Learning, Informatics, Management & Ethics, Karolinska Institute, Stockholm, Sweden.
    Elwyn, Glyn
    The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA.
    Value-based healthcare’s blind spots: call for a dialogue2021In: F1000 Research, E-ISSN 2046-1402, Vol. 10, article id 1314Article in journal (Refereed)
    Abstract [en]

    The value-based healthcare (VBHC) concept was first proposed as a solution to many of the ills of healthcare. Since then, we have seen the term “value” defined, used, confused, and interpreted in multiple ways. While we may disagree that competition based on value will solve healthcare’s complex challenges, value is a concept integral to the future of healthcare. Before VBHC becomes consigned to the long list of quality improvement trends and management fads that have passed through healthcare, we call for a dialogue around the term value and the implications of its different interpretations. The intention is not just to critique, but to facilitate ongoing efforts to substantially improve healthcare in ways that are relevant and sustainable for society at large.

  • 2.
    Karmelić, Ema
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Lindlöf, Henrik
    Karolinska Institutet, Stockholm, Sweden; The Ambulance Medical Service of Region Västmanland, Västerås, Sweden.
    Luckhaus, Jamie Linnea
    Karolinska Institutet, Stockholm, Sweden.
    Castillo, Moa Malmqvist
    Karolinska Institutet, Stockholm, Sweden.
    Vicente, Veronica
    Karolinska Institutet, Stockholm, Sweden; The Ambulance Medical Service in Stockholm (AISAB), Stockholm, Sweden; Academic EMS, Stockholm, Sweden.
    Härenstam, Karin Pukk
    Karolinska Institutet, Stockholm, Sweden.
    Savage, Carl
    Halmstad University, School of Health and Welfare. Karolinska Institutet, Stockholm, Sweden.
    Decision-making on the fly: a qualitative study of physicians in out-of-hospital emergency medical services2023In: BMC Emergency Medicine, ISSN 1471-227X, E-ISSN 1471-227X, Vol. 23, article id 65Article in journal (Refereed)
    Abstract [en]

    Background: Out-of-hospital Emergency Medical Services (OHEMS) require fast and accurate assessment of patients and efficient clinical judgment in the face of uncertainty and ambiguity. Guidelines and protocols can support staff in these situations, but there is significant variability in their use. Therefore, the aim of this study was to increase our understanding of physician decision-making in OHEMS, in particular, to characterize the types of decisions made and to explore potential facilitating and hindering factors. Methods: Qualitative interview study of 21 physicians in a large, publicly-owned and operated OHEMS in Croatia. Data was subjected to an inductive content analysis. Results: Physicians (mostly young, female, and early in their career), made three decisions (transport, treat, and if yes on either, how) after an initial patient assessment. Decisions were influenced by patient needs, but to a greater extent by factors related to themselves and patients (microsystem), their organization (mesosystem), and the larger health system (macrosystem). This generated a high variability in quality and outcomes. Participants desired support through further training, improved guidelines, formalized feedback, supportive management, and health system process redesign to better coordinate and align care across organizational boundaries. Conclusions: The three decisions were made complex by contextual factors that largely lay outside physician control at the mesosystem level. However, physicians still took personal responsibility for concerns more suitably addressed at the organizational level. This negatively impacted care quality and staff well-being. If managers instead adopt a learning orientation, the path from novice to expert physician could be more ably supported through organizational demands and practices aligned with real-world practice. Questions remain on how managers can better support the learning needed to improve quality, safety, and physicians’ journey from novice to expert. © 2023, The Author(s).

  • 3.
    Keel, George
    et al.
    Learning, Informatics, Management, and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Muhammad, Rafiq
    Learning, Informatics, Management, and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Savage, Carl
    Learning, Informatics, Management, and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Spaak, Jonas
    Learning, Informatics, Management, and Ethics, Karolinska Institutet, Stockholm, Sweden; Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Gonzalez, Ismael
    Learning, Informatics, Management, and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Lindgren, Peter
    Learning, Informatics, Management, and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Guttmann, Christian
    Learning, Informatics, Management, and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Mazzocato, Pamela
    Learning, Informatics, Management, and Ethics, Karolinska Institutet, Stockholm, Sweden; Research, Development, Education and Innovation, Södertälje Hospital, Södertälje, Sweden.
    Time-driven activity-based costing for patients with multiple chronic conditions: a mixed-method study to cost care in a multidisciplinary and integrated care delivery centre at a university-affiliated tertiary teaching hospital in Stockholm, Sweden2020In: BMJ Open, E-ISSN 2044-6055, Vol. 10, no 6, article id e032573Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: This study can be applied to cost the complex non-standardised processes used to treat patients with multiple chronic conditions. DESIGN: A mixed-method approach to cost analysis, following a modified healthcare-specific version of the seven-step Time-Driven Activity-Based Costing (TDABC) approach. SETTING: A multidisciplinary integrated and person-centred care delivery centre at a university-affiliated tertiary teaching hospital in Stockholm, Sweden, designed to improve care coordination for patients with multiple chronic conditions, specifically diabetes, cardiovascular disease and kidney disease. PARTICIPANTS: 314 patients (248 men and 66 women) fit inclusion criteria. Average age was 80 years. RESULTS: This modified TDABC analysis costed outpatient care for patients with multiple chronic conditions. The approach accounted for the difficulty of conceptualising care cycles. The estimated total cost, stratified by resources, can be reviewed together with existing managerial accounting statements to inform management decisions regarding the multidisciplinary centre. CONCLUSIONS: This article demonstrates that the healthcare-specific seven-step approach to TDABC can be applied to cost care for patients with multiple chronic conditions, where pathways are not yet discernable. It became clear that there was a need for slight methodological adaptations for this particular patient group to make it possible to cost these pathways, stratified by activity and resource. The value of this approach can be discerned from the way management incorporated the results of this analysis into the development of their hospital strategy. In the absence of integrated data infrastructures that can link patients and resources across financial, clinical and process data sets, the scalability of this method will be difficult. © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

  • 4.
    Nilsen, Per
    et al.
    Halmstad University, School of Health and Welfare. Linköping University, Linköping, Sweden.
    Reed, Julie
    Halmstad University, School of Health and Welfare.
    Nair, Monika
    Halmstad University, School of Health and Welfare.
    Savage, Carl
    Halmstad University, School of Health and Welfare. Karolinska Institutet, Stockholm, Sweden.
    Macrae, Carl
    Halmstad University, School of Health and Welfare. Nottingham University Business School, Nottingham, United Kingdom.
    Barlow, James
    Halmstad University, School of Business, Innovation and Sustainability. Imperial College Business School, London, United Kingdom.
    Svedberg, Petra
    Halmstad University, School of Health and Welfare.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare.
    Lundgren, Lina
    Halmstad University, School of Business, Innovation and Sustainability.
    Nygren, Jens M.
    Halmstad University, School of Health and Welfare.
    Realizing the potential of artificial intelligence in healthcare: Learning from intervention, innovation, implementation and improvement sciences2022In: Frontiers in Health Services, E-ISSN 2813-0146, Vol. 2, article id 961475Article in journal (Refereed)
    Abstract [en]

    Introduction: Artificial intelligence (AI) is widely seen as critical for tackling fundamental challenges faced by health systems. However, research is scant on the factors that influence the implementation and routine use of AI in healthcare, how AI may interact with the context in which it is implemented, and how it can contribute to wider health system goals. We propose that AI development can benefit from knowledge generated in four scientific fields: intervention, innovation, implementation and improvement sciences.

    Aim: The aim of this paper is to briefly describe the four fields and to identify potentially relevant knowledge from these fields that can be utilized for understanding and/or facilitating the use of AI in healthcare. The paper is based on the authors' experience and expertise in intervention, innovation, implementation, and improvement sciences, and a selective literature review.

    Utilizing knowledge from the four fields: The four fields have generated a wealth of often-overlapping knowledge, some of which we propose has considerable relevance for understanding and/or facilitating the use of AI in healthcare.

    Conclusion: Knowledge derived from intervention, innovation, implementation, and improvement sciences provides a head start for research on the use of AI in healthcare, yet the extent to which this knowledge can be repurposed in AI studies cannot be taken for granted. Thus, when taking advantage of insights in the four fields, it is important to also be explorative and use inductive research approaches to generate knowledge that can contribute toward realizing the potential of AI in healthcare. © 2022 Nilsen, Reed, Nair, Savage, Macrae, Barlow, Svedberg, Larsson, Lundgren and Nygren. 

  • 5.
    Rafiq, Muhammad
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Keel, George
    Karolinska Institutet, Stockholm, Sweden.
    Mazzocato, Pamela
    Karolinska Institutet, Stockholm, Sweden; Södertälje Hospital, Södertälje, Sweden.
    Spaak, Jonas
    Karolinska Institutet, Stockholm, Sweden; Danderyd University Hospital, Karolinska Institutet, Stockholm.
    Guttmann, Christian
    Karolinska Institutet, Stockholm, Sweden; Tieto Sweden AB, Stockholm, Sweden; Nordic Artificial Intelligence Institute, Stockholm, Sweden.
    Lindgren, Peter
    Karolinska Institutet, Stockholm, Sweden.
    Savage, Carl
    Karolinska Institutet, Stockholm, Sweden.
    Extreme Consumers of Health Care: Patterns of Care Utilization in Patients with Multiple Chronic Conditions Admitted to a Novel Integrated Clinic2019In: Journal of Multidisciplinary Healthcare, ISSN 1178-2390, E-ISSN 1178-2390, Vol. 12, p. 1075-1083Article in journal (Refereed)
    Abstract [en]

    Purpose: Patients with multiple chronic conditions (MCC) of diabetes, cardiovascular and kidney diseases; hereafter referred to as HND (heart/cardiac-, nephrology-, diabetes mellitus-) patients, are high utilizers of health care. However, the care received is often insufficiently coordinated between different specialties and health-care providers. This study aims to describe the characteristics of HND patients and to explore the initial effects of a multidisciplinary and person-centered care on total care utilization.

    Patients and Methods: We conducted a sub-study of HND patients recruited in an ongoing randomized trial CareHND (NCT03362983). Descriptive statistics of patient characteristics, including diagnostic data and Charlson Comorbidity Index scores, informed a comparison of care utilization patterns between HND patient care and traditional care. Diagnostic and care utilization data were collected from a regional database. Wilcoxon signed ranked sum tests were performed to compare care utilization frequencies between the two groups.

    Results: Patients included in the study were care-intensive with several diagnoses and experienced a high level of variation in care utilization and diagnoses profiles. HND patients were sicker than their counterparts in the control group. Utilization indicators were similar between the two arms. There was some indication that the HND center is beginning to perform as expected, but no results were statistically significant.

    Conclusion: This study sits among many studies reporting difficulties obtaining statistically significant findings for MCC patients. However, previous research has shown that the key components of this intervention, such as integrated, multidisciplinary, inter-professional collaboration within patient-centered care have had a positive effect on health-care outcomes. More innovative methods beyond the RCT, such as machine learning should be explored to evaluate the impact of integrated care interventions on care utilization.

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  • 6.
    Ramos, Pedro
    et al.
    Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Sweden; Hospital Israelita Albert Einstein, São Paulo, Brazil.
    Savage, Carl
    Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Sweden.
    Thor, Johan
    Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Sweden.
    Atun, Rifat
    Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, MA, USA.
    Carlsson, Karin Solberg
    Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Sweden.
    Makdisse, Marcia
    Hospital Israelita Albert Einstein, São Paulo, Brazil.
    Neto, Miguel Cendoroglo
    Hospital Israelita Albert Einstein, São Paulo, Brazil.
    Klajner, Sidney
    Hospital Israelita Albert Einstein, São Paulo, Brazil.
    Parini, Paolo
    Theme Inflammation and Infection, Karolinska University Hospital, Sweden.
    Mazzocato, Pamela
    Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Sweden.
    It takes two to dance the VBHC tango: A multiple case study of the adoption of value-based strategies in Sweden and Brazil2021In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 282, article id 114145Article in journal (Refereed)
    Abstract [en]

    Although Value-Based Health Care (VBHC) is widely debated and cited, there are few empirical studies focused on how its concepts are understood and applied in real-world contexts. This comparative case study of two prominent adopters in Brazil and Sweden, situated at either end of the spectrum in terms of contextual prerequisites, provides insights into the complex interactions involved in the adoption of value-based strategies. We found that the adoption of VBHC emphasized either health outcomes or costs – not both as suggested by the value equation. This may be linked to broader health system and societal contexts. Implementation can generate tensions with traditional business models, suggesting that providers should first analyze how these strategies align with their internal context. Adoption by a single provider organization is challenging, if not impossible. An effective VBHC transformation seems to require a systematic and systemic approach where all stakeholders need to clearly define the purpose and the scope of the transformation, and together steer their actions and decisions accordingly. © 2021 The Authors

  • 7.
    Reinius, Maria
    et al.
    Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Mazzocato, Pamela
    Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Riggare, Sara
    Department of Women's and Children's Health, Healthcare Sciences and E-Health, Uppsala University, Uppsala, Sweden.
    Bylund, Ami
    Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Jansson, Hanna
    Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Øvretveit, John
    Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden; Department of Research Development and Education, Region Stockholm, Stockholm, Sweden.
    Savage, Carl
    Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Wannheden, Carolina
    Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Hasson, Henna
    Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden; Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden.
    Patient-driven innovations reported in peer-reviewed journals: a scoping review2022In: BMJ Open, E-ISSN 2044-6055, Vol. 12, no 1, article id e053735Article in journal (Refereed)
    Abstract [en]

    Background

    Awareness of patients’ innovative capabilities is increasing, but there is limited knowledge regarding the extent and nature of patient-driven innovations in the peer-reviewed literature.

    Objectives

    The objective of the review was to answer the question: what is the nature and extent of patient-driven innovations published in peer-reviewed scientific journals?

    Eligibility criteria

    We used a broad definition of innovation to allow for a comprehensive review of different types of innovations and a narrow definition of ‘patient driven’ to focus on the role of patients and/or family caregivers. The search was limited to years 2008–2020.

    Sources of evidence

    Four electronic databases (Medline (Ovid), Web of Science Core Collection, PsycINFO (Ovid) and Cinahl (Ebsco)) were searched in December 2020 for publications describing patient-driven innovations and complemented with snowball strategies.

    Charting methods

    Data from the included articles were extracted and categorised inductively.

    Results

    A total of 96 articles on 20 patient-driven innovations were included. The number of publications increased over time, with 69% of the articles published between 2016 and 2020. Author affiliations were exclusively in high income countries with 56% of first authors in North America and 36% in European countries. Among the 20 innovations reported, ‘Do-It-Yourself Artificial Pancreas System‘ and the online health network ‘PatientsLikeMe’, were the subject of half of the articles.

    Conclusions

    Peer-reviewed publications on patient-driven innovations are increasing and we see an important opportunity for researchers and clinicians to support patient innovators’ research while being mindful of taking over the work of the innovators themselves.

  • 8.
    Savage, Carl
    et al.
    Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Bjessmo, Staffan
    Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Borisenko, Oleg
    Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Larsson, Henrik
    Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Karlsson, Jacob
    Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Mazzocato, Pamela
    Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Translating ‘See-and-Treat’ to primary care: opening the gates does not cause a flood2019In: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 31, no 7, p. 30-36Article in journal (Refereed)
    Abstract [en]

    Objective: To explore how the See-and-Treat concept can be applied in primary care and its effect on volume and productivity. Design: An explanatory single-case study design with a mixed methods approach and presented according to the SQUIRE 2.0 guidelines. Setting: A publicly-funded, private primary care provider within the Stockholm County, which caters to a diverse patient population in terms of ethnicity, religion, socioeconomic status and care needs. Participants: CEO, center manager, four physicians, two licensed practical nurses, one medical secretary and one lab assistant. Intervention: A See-and-Treat unit was established to offer same-day service for acute unplanned visits. Standardized patient symptom forms were created that allowed patients to self-triage and then enter into a streamlined care process consisting of a quick diagnostic lab and a physician visit. Main Outcome Measures: Volume, productivity, staff perceptions and patient satisfaction were measured through data on number and type of contacts per 1000 listed patients, visits per physician, observations, interviews and a questionnaire. Results: A significant decrease in the acute and total number of visits, a continued trend of diminishing telephone contacts, and a non-significant increase in physician productivity. Patients were very satisfied, and staff perceived an improved quality of care. Conclusions: See-and-Treat appears to be a viable approach for a specific primary care patient segment interested in acute same-day-service. Opening up access and standardizing care made it possible to efficiently address these needs and engage patients. © 2019 The Author(s) 2019. Published by Oxford University Press in association with the International Society for Quality in Health Care.

  • 9.
    Savage, Mairi
    et al.
    Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Savage, Carl
    Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Brommels, Mats
    Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Mazzocato, Pamela
    Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Medical leadership: boon or barrier to organisational performance? A thematic synthesis of the literature2020In: BMJ Open, E-ISSN 2044-6055, Vol. 10, no 7, article id e035542Article in journal (Refereed)
    Abstract [en]

    Objective

    The influx of management ideas into healthcare has triggered considerable debate about if and how managerial and medical logics can coexist. Recent reviews suggest that clinician involvement in hospital management can lead to superior performance. We, therefore, sought to systematically explore conditions that can either facilitate or impede the influence of medical leadership on organisational performance.

    Design

    Systematic review using thematic synthesis guided by the Enhancing Transparency in Reporting the synthesis of Qualitative research statement.

    Data sources

    We searched PubMed, Web of Science and PsycINFO from 1 January 2006 to 21 January 2020.

    Eligibility criteria

    We included peer-reviewed, empirical, English language articles and literature reviews that focused on physicians in the leadership and management of healthcare.

    Data extraction and synthesis

    Data extraction and thematic synthesis followed an inductive approach. The results sections of the included studies were subjected to line-by-line coding to identify relevant meaning units. These were organised into descriptive themes and further synthesised into analytic themes presented as a model.

    Results

    The search yielded 2176 publications, of which 73 were included. The descriptive themes illustrated a movement from 1. medical protectionism to management through medicine; 2. command and control to participatory leadership practices; and 3. organisational practices that form either incidental or willing leaders. Based on the synthesis, the authors propose a model that describes a virtuous cycle of management through medicine or a vicious cycle of medical protectionism.

    Conclusions

    This review helps individuals, organisations, educators and trainers better understand how medical leadership can be both a boon and a barrier to organisational performance. In contrast to the conventional view of conflicting logics, medical leadership would benefit from a more integrative model of management and medicine. Nurturing medical engagement requires participatory leadership enabled through long-term investments at the individual, organisational and system levels.

  • 10.
    Sharma, Malvika
    et al.
    Karolinska Institutet, Medical Management Centre, Stockholm, Sweden.
    Savage, Carl
    Halmstad University, School of Health and Welfare. Karolinska Institutet, Medical Management Centre, Stockholm, Sweden.
    Nair, Monica
    Halmstad University, School of Health and Welfare.
    Larsson, Ingrid
    Halmstad University, School of Health and Welfare.
    Svedberg, Petra
    Halmstad University, School of Health and Welfare.
    Nygren, Jens M.
    Halmstad University, School of Health and Welfare.
    Artificial Intelligence Applications in Health Care Practice: Scoping Review2022In: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 24, no 10, article id e40238Article in journal (Refereed)
    Abstract [en]

    Background: Artificial intelligence (AI) is often heralded as a potential disruptor that will transform the practice of medicine. The amount of data collected and available in health care, coupled with advances in computational power, has contributed to advances in AI and an exponential growth of publications. However, the development of AI applications does not guarantee their adoption into routine practice. There is a risk that despite the resources invested, benefits for patients, staff, and society will not be realized if AI implementation is not better understood.

    Objective: The aim of this study was to explore how the implementation of AI in health care practice has been described and researched in the literature by answering 3 questions: What are the characteristics of research on implementation of AI in practice? What types and applications of AI systems are described? What characteristics of the implementation process for AI systems are discernible?

    Methods: A scoping review was conducted of MEDLINE (PubMed), Scopus, Web of Science, CINAHL, and PsycINFO databases to identify empirical studies of AI implementation in health care since 2011, in addition to snowball sampling of selected reference lists. Using Rayyan software, we screened titles and abstracts and selected full-text articles. Data from the included articles were charted and summarized.

    Results: Of the 9218 records retrieved, 45 (0.49%) articles were included. The articles cover diverse clinical settings and disciplines; most (32/45, 71%) were published recently, were from high-income countries (33/45, 73%), and were intended for care providers (25/45, 56%). AI systems are predominantly intended for clinical care, particularly clinical care pertaining to patient-provider encounters. More than half (24/45, 53%) possess no action autonomy but rather support human decision-making. The focus of most research was on establishing the effectiveness of interventions (16/45, 35%) or related to technical and computational aspects of AI systems (11/45, 24%). Focus on the specifics of implementation processes does not yet seem to be a priority in research, and the use of frameworks to guide implementation is rare.

    Conclusions: Our current empirical knowledge derives from implementations of AI systems with low action autonomy and approaches common to implementations of other types of information systems. To develop a specific and empirically based implementation framework, further research is needed on the more disruptive types of AI systems being implemented in routine care and on aspects unique to AI implementation in health care, such as building trust, addressing transparency issues, developing explainable and interpretable solutions, and addressing ethical concerns around privacy and data protection.Keywords: artificial intelligence; health care; implementation; scoping review; technology adoption.©Malvika Sharma, Carl Savage, Monika Nair, Ingrid Larsson, Petra Svedberg, Jens M Nygren. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 05.10.2022.

  • 11.
    Siira, Elin
    et al.
    Halmstad University, School of Health and Welfare. University of Gothenburg, Gothenburg, Sweden.
    Svedberg, Petra
    Halmstad University, School of Health and Welfare.
    Savage, Carl
    Halmstad University, School of Health and Welfare. Karolinska Institutet, Stockholm, Sweden.
    Nygren, Jens M.
    Halmstad University, School of Health and Welfare.
    What Are We Talking About When We Talk About Information-Driven Care? A Delphi-Study on a Definition2023In: Studies in Health Technology and Informatics, ISSN 0926-9630, E-ISSN 1879-8365, Vol. 302, p. 346-347Article in journal (Refereed)
    Abstract [en]

    In Sweden, the term information-driven care has recently been put forward by healthcare organizations and researchers as a means for taking a comprehensive approach to the introduction of Artificial Intelligence (AI) in healthcare. The aim of this study is to systematically generate a consensus definition of the term information-driven care. To this end, we are conducting a Delphi study utilizing literature and experts' opinions. The definition is needed to enable knowledge exchange on information-driven care and operationalize its introduction into healthcare practice. © 2023 European Federation for Medical Informatics (EFMI) and IOS Press.

  • 12.
    Storkholm, Marie Höjriis
    et al.
    Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden; Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.
    Mazzocato, Pamela
    Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Savage, Carl
    Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Make it complicated: a qualitative study utilizing a complexity framework to explain improvement in health care2019In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 19, no 1, article id 842Article in journal (Refereed)
    Abstract [en]

    Background

    Successful application of Quality Improvement (QI) methods is challenging, and awareness of the role context plays has increased. Complexity science has been advocated as a way to inform change efforts. However, empirical support is scarce, and it is still difficult to grasp the practical implications for QI interventions. The aim of this study was to use a complexity-based leadership framework to explain how managers in a clinical department addressed external requirements to cut costs without compromising patient outcomes and experience.

    Methods

    Explanatory case study design of a Danish OB/GYN department tasked to improve efficiency. Data came from documents, 30 interviews, and 250 h of observations over 3 years. A Complexity Analysis Framework that combined two complexity-based leadership frameworks was developed to analyze all changes implemented to reduce cost, while maintaining clinical quality.

    Results

    Managers reframed the efficiency requirement as an opportunity for quality improvement. Multiple simple, complicated, and complex situations were addressed with an adaptive approach to quality improvement. Changes were made to clinical pathways for individual conditions (n = 37), multiple conditions (n = 7), and at the organizational level (n = 9). At the organizational level, changes addressed referral practice, physical space in the department, flow and capacity, discharge speed, and managerial support. Managers shared responsibility with staff; together they took a “professional path” and systematically analyzed each clinical pathway through process mapping, attentive to patterns that emerged, before deciding on the next steps, such as a engaging in a complex process of probing – the iterative development and testing of new responses.

    Conclusions

    Quality improvement efforts could benefit from an understanding of the importance of learning and sharing responsibility to deal with the co-existing degrees of contextual complexity in modern health care. By “making things complicated” through a systematic analysis that engages staff in an open and reflective dialog, clinical praxis and established organizational structures can be questioned and improved. The Complexity Analysis Framework could then help managers to identify improvement opportunities, know when to implement technical solutions, and when to keep abreast of emerging patterns and allow appropriate responses to complex challenges to evolve.

  • 13.
    Storkholm, Marie Höjriis
    et al.
    Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden; Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.
    Savage, Carl
    Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Tessma, Mesfin Kassaye
    Medical Statistics Unit, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Salvig, Jannie Dalby
    Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.
    Mazzocato, Pamela
    Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Ready for the Triple Aim? Perspectives on organizational readiness for implementing change from a Danish obstetrics and gynecology department2019In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 19, no 1, article id 517Article in journal (Refereed)
    Abstract [en]

    Background: As health care strives towards the Triple Aim of improved population health, patient experience, and reduced costs, an organization’s readiness for change may be a key factor. The concept refers to the collective commitment of organizational members to a change and belief in their shared ability to make that change happen (efficacy). This study aims to assess the organizational readiness for implementing large-scale change at a clinical department in pursuit of the Triple Aim and to determine key associated factors.

    Methods: A cross-sectional study at a Danish Obstetrics and Gynecology department faced with external pressure to become more efficient without compromising patient outcomes and experience. The Organisational Readiness for Implementing Change (ORIC) questionnaire was distributed to all employees (n = 403). Descriptive statistics was used to assess overall organizational readiness and single items. The between-group differences in subject characteristics were assessed with independent t-test and non-parametric test. Multiple linear regression was employed to control for potential confounders.

    Results: Response rate was 72%. The level of agreement with the commitment statements was high, and low with the efficacy statements. We did not observe statistically significant differences in the overall score between organizational sections or in relation to gender, age, or profession. Managerial status (B = 3.2, 95% CI = .52, 5.9, P = .02) or interim employment(B = 2.7, 95% CI = .47, 4.9, P = .02) were significant predictors of a high change efficacy score after controlling for potential confounders.

    Conclusions: Changes related to pursuit of the Triple Aim were seen as something that “has to” be done, but left managers, and even more so staff, wondering what “to do” and “how to” do it. Change strategies should therefore address these uncertainties by translating political “have to’s” proposals that resonate with staff, spark engagement, and clarify “how to” deal with the complexity of large-scale change.

  • 14.
    Tragl, Leonard
    et al.
    Medical Management Centre, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institute, Stockholm, Sweden.
    Savage, Carl
    Medical Management Centre, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institute, Stockholm, Sweden.
    Andreen-Sachs, Magna
    Medical Management Centre, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institute, Stockholm, Sweden.
    Brommels, Mats
    Medical Management Centre, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institute, Stockholm, Sweden.
    Who counts when health counts? A case-study of multi-stakeholder initiative to promote value-creation in Swedish healthcare2022In: Health Services Management Research, ISSN 0951-4848, E-ISSN 1758-1044Article in journal (Refereed)
    Abstract [en]

    A European initiative to design a “medical information framework” conceptualised how multiple stakeholders join in collaborative networks to create innovations. It conveyed the ways in which value is created and captured by stakeholders. We applied those insights to analyse a multi-stakeholder initiative to promote improvement of Swedish healthcare. Our longitudinal case study covered totally fifty stakeholders involved in a national project, aiming at designing a system to support value-based evaluation and reimbursement. During the project the focus changed from reimbursement to benchmarking. Sophisticated case-mix adjusting algorithms were designed to make outcome comparisons valid and incorporated in a software platform enabling detailed analysis of eight patient groups across seven regional health authorities. Those were deliverables demonstrating value created. However, the project was unable to transfer the system into routine use in the regions, a failed value-capture. The initial success was promoted by collaborative processes in diagnosis-specific working groups of well-informed and engaged professionals. The change of focus away from reimbursement decreased the involvement among health authorities, leaving no centrally placed persons to push for implementation. It highlights the importance of health professionals as the key stakeholder, who has both the know-how instrumental to creating an innovation, and the local involvement guaranteeing its implementation.

  • 15.
    von Thiele Schwarz, Ulrica
    et al.
    Mälardalen University, Västerås, Sweden; Karolinska Institutet, Stockholm, Sweden.
    Nielsen, Karina
    The University of Sheffield, Sheffield, United Kingdom.
    Edwards, Kasper
    Technical University of Denmark, Lyngby, Denmark.
    Hasson, Henna
    Karolinska Institutet, Stockholm, Sweden; Center for Epidemiology and Community Medicine, Stockholm, Sweden.
    Ipsen, Christine
    Technical University of Denmark, Lyngby, Denmark.
    Savage, Carl
    Karolinska Institutet, Stockholm, Sweden.
    Simonsen Abildgaard, Johan
    National Research Center for Working Environment, Copenhagen, Denmark.
    Richter, Anne
    Karolinska Institutet, Stockholm, Sweden; Center for Epidemiology and Community Medicine, Stockholm, Sweden.
    Lornudd, Caroline
    Karolinska Institutet, Stockholm, Sweden.
    Mazzocato, Pamela
    Karolinska Institutet, Stockholm, Sweden.
    Reed, Julie E.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). NIHR CLAHRC for Northwest London, Chelsea and Westminster Hospital, London, United Kingdom.
    How to design, implement and evaluate organizational interventions for maximum impact: the Sigtuna Principles2021In: European Journal of Work and Organizational Psychology, ISSN 1359-432X, E-ISSN 1464-0643, Vol. 30, no 3, p. 415-427Article in journal (Refereed)
    Abstract [en]

    Research on organizational interventions needs to meet the objectives of both researchers and participating organizations. This duality means that real-world impact has to be considered throughout the research process, simultaneously addressing both scientific rigour and practical relevance. This discussion paper aims to offer a set of principles, grounded in knowledge from various disciplines that can guide researchers in designing, implementing, and evaluating organizational interventions. Inspired by Mode 2 knowledge production, the principles were developed through a transdisciplinary, participatory and iterative process where practitioners and academics were invited to develop, refine and validate the principles. The process resulted in 10 principles: 1) Ensure active engagement and participation among key stakeholders; 2) Understand the situation (starting points and objectives); 3) Align the intervention with existing organizational objectives; 4) Explicate the program logic; 5) Prioritize intervention activities based on effort-gain balance; 6) Work with existing practices, processes, and mindsets; 7) Iteratively observe, reflect, and adapt; 8) Develop organizational learning capabilities; 9) Evaluate the interaction between intervention, process, and context; and 10) Transfer knowledge beyond the specific organization. The principles suggest how the design, implementation, and evaluation of organizational interventions can be researched in a way that maximizes both practical and scientific impact. © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

  • 16.
    Wannheden, Carolina
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Riggare, Sara
    Uppsala University, Uppsala, Sweden.
    Luckhaus, Jamie L.
    Karolinska Institutet, Stockholm, Sweden.
    Jansson, Hanna
    Karolinska Institutet, Stockholm, Sweden.
    Sjunnestrand, My
    Karolinska Institutet, Stockholm, Sweden.
    Stenfors, Terese
    Karolinska Institutet, Stockholm, Sweden.
    Savage, Carl
    Halmstad University, School of Health and Welfare. Karolinska Institutet, Stockholm, Sweden.
    Reinius, Maria
    Karolinska Institutet, Stockholm, Sweden.
    Hasson, Henna
    Karolinska Institutet, Stockholm, Sweden; Center For Epidemiology And Community Medicine (ces), Stockholm, Sweden.
    A rocky road but worth the drive: A longitudinal qualitative study of patient innovators and researchers cocreating research2023In: Health Expectations, ISSN 1369-6513, E-ISSN 1369-7625, Vol. 26, no 4, p. 1757-1767Article in journal (Refereed)
    Abstract [en]

    Background: Partnership research practices involving various stakeholder groups are gaining ground. Yet, the research community is still exploring how to effectively coproduce research together. This study describes (a) key programme developments in the creation of a 6-year partnership research programme in Sweden, and (b) explores the hopes, expectations, and experiences of patient innovators (i.e., individuals with lived experience as patients or caregivers who drive health innovations) and researchers involved in the programme during the first years. Methods: We conducted a prospective longitudinal qualitative study spanning the first 2 years of the programme. Data consisted of meeting protocols and interviews with 14 researchers and 6 patient innovators; 39 interviews were carried out in three evenly-spaced rounds. We identified significant events and discussion themes in the meeting protocols and analyzed the interviews using thematic analysis, applying a cross-sectional recurrent approach to track changes over time. Findings: Meeting protocols revealed how several partnership practices (e.g., programme management team, task forces, role description document) were cocreated, supporting the sharing of power and responsibilities among programme members. Based on the analysis of interviews, we created three themes: (1) paving the path to a better tomorrow, reflecting programme members' high expectations; (2) going on a road trip together, reflecting experiences of finding new roles and learning how to cocreate; (3) finding the tempo: from talking to doing, reflecting experiences of managing challenges and becoming productive as a team. Conclusions: Our findings suggest that sharing, respecting, and acknowledging each other's experiences and concerns helps build mutual trust and shape partnership practices. High expectations beyond research productivity suggest that we need to consider outcomes at different levels, from the individual to society, when evaluating the impact of partnership research. Patient or Public Contribution: The research team included members with formal experiences as researchers and members with lived experiences of being a patient or informal caregiver. One patient innovator coauthored this paper and contributed to all aspects of the research, including the design of the study; production of data (as interviewee); interpretation of findings; and drafting the manuscript. © 2023 The Authors. Health Expectations published by John Wiley & Sons Ltd.

  • 17.
    Wohlin, Jonas
    et al.
    Accumbo AB, Kalmar, Sweden; Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Fischer, Clara
    Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Carlsson, Karin Solberg
    Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Korlén, Sara
    Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Mazzocato, Pamela
    Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Savage, Carl
    Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Stalberg, Holger
    Region Stockholm, Stockholm, Sweden.
    Brommels, Mats
    Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    As predicted by theory: choice and competition in a publicly funded and regulated regional health system yield improved access and cost control2021In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 21, article id 406Article in journal (Refereed)
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