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"Samhandling is considered as a key solution when asymmetry occurs. An
expectation of seamless samhandling can be a special challenge to High Reliability
Organizations
which have mechanistic traditions in common, i.e. an assumption of
linearity and routine-based work. In this chapter, a model to operationalize samhandling
is presented. This conceptual study is based on observational data from an
inter-organizational exercise. A full-scale exercise of a train accident on the Öresund
Bridge between Sweden and Denmark was observed. The overall goal of the exercise
was to effectively solve the situation. However, different routines contributed to
confusion and misunderstandings in the meeting on how to act. The exercise was
dominated by a focus on linearity within the internal organizations, which hindered
samhandling. In order to conceptualize samhandling, a three-level model is presented.
It consists of "sequential samhandling", i.e. a simplified, assembly-line type work
process, "parallel samhandling", i.e. carrying out tasks simultaneously, and "synchronous
samhandling", i.e. tasks performed at the same time in a spontaneous and natural
way. A three-level samhandling model such as the one presented can be a useful
tool for managing disasters."

English summary u.d.T.: In the shadow of Ädel - integration in municipial home-care

This article reviews the traditions of the health care industry while challenged by trends. Strong professions, ambiguous and contradictory aims, and a lack of resources have contributed to difficulties managing contradictory needs. One way to handle the situation is to introduce systems based on freedom of choice, inter organisational and professional work, and an improved degree of flexibility. The trends are mainly influenced by New Public Management control models. The mixture of new and traditional types of management control has produced organisational hybrids. These organisational hybrids have contributed to organisational tensions from the old as well as the new in an inconsistent but regenerating way.

BACKGROUND: Establishing more substantial patient involvement in the health care has become fundamental to Western health care services. Person-centred care (PCC) has been developed as a way of working that involve the patients and family members. However, the implementation of PCC in clinical practice has proven to be challenging. The aim of this study was to explore the congruence of managers' perceptions and understanding of various aspects of PCC across three organisational levels in one health care region in Sweden in terms of coupling, decoupling and recoupling. METHODS: A policy on increased patient participation in health care was adopted in one health care region in Sweden. This policy was embodied in the form of PCC and a support strategy for the implementation was put in place. Participants representing three organisational levels (senders: politicians, n = 3; messengers: senior management, n = 7; and receivers: middle- and frontline managers, n = 13) were interviewed and documents collected. A deductive qualitative content analysis was performed and findings from the three organisational levels compared. RESULTS: Descriptions of PCC at all the three organisational levels included health care provided in partnership between provider and patient. However, messengers and receivers also included aspects of how work was organised as part of the concept. Representatives at all levels expected high-quality care while reducing health care costs as an outcome, however, messengers and receivers also anticipated improvements in the work environment and reduced staff turnover. Strategies to support implementation included continuation and enhancement of existing routines that were considered person-centred and development of new ones. A need to make PCC less 'fuzzy' and ambiguous and instead communicate a more tangible care process was described. Representatives among messengers and receivers also suggested that no actions were needed because the practice was already considered person-centred. CONCLUSION: The ...

BACKGROUND: Establishing more substantial patient involvement in the health care has become fundamental to Western health care services. Person-centred care (PCC) has been developed as a way of working that involve the patients and family members. However, the implementation of PCC in clinical practice has proven to be challenging. The aim of this study was to explore the congruence of managers' perceptions and understanding of various aspects of PCC across three organisational levels in one health care region in Sweden in terms of coupling, decoupling and recoupling. METHODS: A policy on increased patient participation in health care was adopted in one health care region in Sweden. This policy was embodied in the form of PCC and a support strategy for the implementation was put in place. Participants representing three organisational levels (senders: politicians, n = 3; messengers: senior management, n = 7; and receivers: middle- and frontline managers, n = 13) were interviewed and documents collected. A deductive qualitative content analysis was performed and findings from the three organisational levels compared. RESULTS: Descriptions of PCC at all the three organisational levels included health care provided in partnership between provider and patient. However, messengers and receivers also included aspects of how work was organised as part of the concept. Representatives at all levels expected high-quality care while reducing health care costs as an outcome, however, messengers and receivers also anticipated improvements in the work environment and reduced staff turnover. Strategies to support implementation included continuation and enhancement of existing routines that were considered person-centred and development of new ones. A need to make PCC less 'fuzzy' and ambiguous and instead communicate a more tangible care process was described. Representatives among messengers and receivers also suggested that no actions were needed because the practice was already considered person-centred. CONCLUSION: The findings indicated that congruence between organisational levels existed in some aspects, suggesting coupling between policy and practice. However, also incongruences were identified that might be due to the fuzziness of definitions and the application of PCC in practice, and the difficulty in assessing the level of patient-centredness in clinical practice. ; Implementing person-centred care: process evaluation of strategies, leadership and health economy using process evaluation, IMPROVE

In this article, we studied collaboration exercises (3LC) between the rescue services, ambulance services, and police force, which were developed to enhance learning and usefulness. The exercises' structure was based on identified deficiencies in previous collaboration exercises. The purpose was to test the exercise model in terms of learning and usefulness. Ten 3LC exercises were observed. A total of 65 semi-structured interviews were conducted (2011–2014) in connection with the exercises. The exercises contained across-boundary elements, seminars, and interactive documentation. The participants were given the opportunity to discuss, analyze, and critically reflect on their efforts. During the seminars, the individual actions were analyzed, which led to alternative strategies that were subsequently tested in a repeated exercise. Our results demonstrate that repetitive features and seminars during collaboration exercises promote learning toward an organic behavior and usefulness in the actual incident work.

The aim of the study was to examine the emergency personnel's perception of the effects of exercises, with regard to learning and usefulness. The exercises were quasi‐experimental and constructed in such a way that employees from different organizations overlapped each other's tasks. This was accomplished by: having asymmetries included in the scenarios, repeating exercise procedures and testing different strategies, which were discussed at joint seminars. The exercises were compared to a similar study, published in this journal, of nonquasiexperimental but merely traditional exercises. Surveys were distributed and collected from emergency personnel in connection with seven exercises. At the exercises, 94.3% of the personnel thought that the exercises had a focus on collaboration (traditional exercises, 75.6%).

This article aims to study whether exercises contribute to learning that can be useful in actual emergency work. It reports the findings of a study about professional emergency personnel's perceptions of the impact of collaboration exercises. Surveys were distributed and collected from emergency personnel in conjunction with three collaboration exercises that took place in Sweden in spring 2012. The survey included personnel holding different positions within the police department, fire department and ambulance services. Among them were also operational personnel such as officers. A total of 94 professional emergency personnel agreed to participate by answering the survey. The response rate was 95%. The study shows that collaborative elements in exercises contribute to perceived learning (R2 = 0:53), and that learning, in turn, has a perceived beneficial effect on actual emergency work (R2 = 0:26). The perceived results of collaboration, learning and their impact on actual emergency work, however, are moderate. The exercises were characterised by long waiting times and gave few opportunities to practise different strategies. Only a few respondents felt that they learned something about the collaborating organisations' ways of communicating and prioritising. Many also thought that the exercises were more useful for command officers than for operational personnel. Thus, the study shows that by strengthening the collaborative elements of the exercises, the perception of the participants' actual emergency work can be developed.