The Sami folk high school started in 1942 as a school for young Sami that needed more education that the Swedish folk school or nomadic school offered its pupils. The school was managed by the Swedish mission society, an organization within the Swedish church. The school was successful but struggled with financial problems. The result was that a foundation with Sami representation managed the school instead after 1972. The following year was even more successful. The number of students increased, and the management could offer more courses and their curriculum had more Sami elements than earlier. However, there was also some conflicts during the 1970s. The largest one being the language boycott addressing the issue of Sami languages at the Sami folk high school as a subject in the school, and as an important part of the Sami culture and identity. This article describes the education of the Sami folk high school's first 40 years with the help of a model for Sami pedagogy developed by Keskitalo and Määttä. The model shows that the education is to a large extent affected by outer factors—self determination, as well as inner factors—language issues and the curriculum. ; Educational democratization and "ethnification" in Swedish Sápmi – 1942 to the present.
This paper reports an action research program designed to develop new approaches for a locally based Swedish R&D unit's task to facilitate improvement in partner organizations, and to provide guidance on how to manage challenges in action research programs focusing on development in health and social care. Data were gathered from interviews with R&D members', managers representing the two embedded pilot cases, as well as from the lead action researchers. Key findings were the need to continually monitor and revise the action research plan and that each step should be given specific weights based on the conditions at hand. As the action program evolved the participants were given autonomy to take action in the partner organizations and the role of the action researchers became advisory and consultative. These findings accentuate the emergent nature of action research and the need for flexible and dynamic intervention planning, especially when multiple level actors and several organizations are involved. Based on these findings we discuss some implications for the action researcher's role and how similar programs can be designed to manage change in complex health and social care systems reaching various stakeholders at many levels.
Background: Comprehensive policies are becoming common for addressing wicked problems in health and social care. Success of these policies often varies between target organizations. This variation can often be attributed to contextual factors. However, there is a lack of knowledge about the conditions for successful policy implementation and how context influences this process. The aim of this study was to investigate county-level actors' perspectives on the implementation of a comprehensive national policy in three Swedish counties. The policy focused on developing quality of care for elderly based on the use of national quality registries (NQRs) and to improve coordination of care. Methods: A comparative case study approach was used. Data was collected longitudinally through documents and interviews. The Consolidated Framework for Implementation Research (CFIR) guided the analysis. Results: All three counties shared the view that the policy addressed important issues. Still, there was variation regarding how it was perceived and managed. Adaptable features-i.e., NQRs and improvement coaches-were perceived as relevant and useful. However, the counties differed in their perceptions of another policy component-i.e., senior management program-as an opportunity or a disturbance. This program, while tackling complex issues of collaboration, fell short in recognizing the counties' pre-existing conditions and needs and also offered few opportunities for adaptations. Performance bonuses and peer pressure were strong incentives for all counties to implement the policy, despite the poor fit of policy content and local context. Conclusions: Comprehensive health policies aiming to address wicked problems have better chances of succeeding if the implementation includes assessments of the target organizations' implementation capacity as well as the implicit quid pro quos involved in policy development. Special attention is warranted regarding the use of financial incentives when dealing with wicked problems since the complexity makes it difficult to align incentives with the goals and to assess potential consequences. Other important aspects in the implementation of such policies are the use of collaborative approaches to engage stakeholders with differing perspectives, and the tailoring of policy communication to facilitate shared understanding and commitment.
BACKGROUND: Large-scale change initiatives stimulating change in several organizational systems in the health and social care sector are challenging both to lead and evaluate. There is a lack of systematic research that can enrich our understanding of strategies to facilitate large system transformations in this sector. The purpose of this study was to examine the characteristics of core activities and strategies to facilitate implementation and change of a national program aimed at improving life for the most ill elderly people in Sweden. The program outcomes were also addressed to assess the impact of these strategies. METHODS: A longitudinal case study design with multiple data collection methods was applied. Archival data (n = 795), interviews with key stakeholders (n = 11) and non-participant observations (n = 23) were analysed using content analysis. Outcome data was obtained from national quality registries. RESULTS: This study presents an approach for implementing a large national change program that is characterized by initial flexibility and dynamism regarding content and facilitation strategies and a growing complexity over time requiring more structure and coordination. The description of activities and strategies show that the program management team engaged a variety of stakeholders and actor groups and accordingly used a palate of different strategies. The main strategies used to influence change in the target organisations were to use regional improvement coaches, regional strategic management teams, national quality registries, financial incentives and annually revised agreements. Interactive learning sessions, intense communication, monitor and measurements, and active involvement of different experts and stakeholders, including elderly people, complemented these strategies. Program outcomes showed steady progress in most of the five target areas, less so for the target of achieving coordinated care. CONCLUSIONS: There is no blue-print on how to approach the challenging task of leading large scale change programs in complex contexts, but our conclusion is that more attention has to be given to the multidimensional strategies that program management need to consider. This multidimensionality comprises different strategies depending on types of actors, system levels, contextual factors, program progress over time, program content, types of learning and change processes, and the conditions for sustainability.
This article investigates the role of locally based research and development units (R&Ds) focusing on health and social services. Nearly 300 local RDs are funded by the Swedish government with the intention to facilitate knowledge transfer and development of high quality and effective health and social care organisations. Based on analyses of archival data on aims, activities and outputs of R&Ds focusing on care for older people the authors argue that local R&Ds have potentials to act as knowledge brokers, change agents and researchers, but these overlapping roles need clarified strategies and enactment of a variety of skills.
Abstract Background Nationwide implementation of guaranteed access to evidence-based rehabilitation was established in Sweden in 2009, through an Act of the Swedish Government. The rehabilitation guarantee's primary goal was to increase the rate of return-to-work, reduce and prevent long-term absenteeism after diagnoses related to back pain and common mental health problems. This study aims to develop knowledge about factors influencing large-scale implementation of complex and extensive interventions in healthcare settings. Methods Three different data sources questionnaires, interviews and documents were used in data collection and analysis. The data were analysed using iterative thematic analysis. Results The following main facilitators contributed to realization of the rehabilitation guarantee: financial incentives, establishment of project organization, recruitment, in-service training and previous experiences of working in similar projects. Barriers were: the rehabilitation guarantee's short-term project-form, clinicians' attitudes to and competence in working towards return-to-work, lack of guidelines describing treatment modalities in multimodal rehabilitation, and lack of well-defined criteria for inclusion of patients. Documents revealed that the return-to-work goal became less pronounced during the implementation process. Instead, care and health were more often described in documents used to disseminate information about the rehabilitation guarantee. Intermediate outcomes found were: patients with rehabilitation needs were given more adequate priority, increased readiness for future implementation efforts, and increased general competence in psychotherapy, and team-work, which thus became available to patient groups other than those covered by the rehabilitation guarantee. Conclusions To facilitate implementation of established national policy goals in clinical practice, tools are needed that specifically aim at changing clinicians' attitudes and behaviours in relation to such goals. Our results underline the importance of investing both time and sufficient resources in the activities and in supporting the implementation process.
Germline mutations in CDKN2A are frequently identified among melanoma kindreds and are associated with increased atypical nevus counts. However, a clear relationship between pathogenic CDKN2A mutation carriage and other nevus phenotypes including counts of common acquired nevi has not yet been established. Using data from GenoMEL, we investigated the relationships between CDKN2A mutation carriage and 2-mm, 5-mm, and atypical nevus counts among blood-related members of melanoma families. Compared with individuals without a pathogenic mutation, those who carried one had an overall higher prevalence of atypical (odds ratio = 1.64; 95% confidence interval = 1.18-2.28) nevi but not 2-mm nevi (odds ratio = 1.06; 95% confidence interval = 0.92-1.21) or 5-mm nevi (odds ratio = 1.26; 95% confidence interval = 0.94-1.70). Stratification by case status showed more pronounced positive associations among non-case family members, who were nearly three times (odds ratio = 2.91; 95% confidence interval = 1.75-4.82) as likely to exhibit nevus counts at or above the median in all three nevus categories simultaneously when harboring a pathogenic mutation (vs. not harboring one). Our results support the hypothesis that unidentified nevogenic genes are co-inherited with CDKN2A and may influence carcinogenesis. ; European Commission under the 6th and 7th Framework Programme ; Cancer Research UK Programme ; Cancer Research UK ; US National Institutes of Health ; NIH, National Cancer Institute (NCI), Division of Cancer Epidemiology and Genetics ; National Health and Medical Research Council of Australia ; Cancer Council New South Wales ; Cancer Institute New South Wales ; Cancer Council Victoria ; Cancer Council Queensland ; CAPES (Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior) ; FAPESP (Fundacao para o Amparo da Pesquisa do Estado de Sao Paulo)-SP, Brazil ; National Health and Medical Research Council of Australia ; NCI ; Cancer Research Foundations of Radiumhemmet ; Swedish Cancer Society ; Paulsson Trust ; Lund University ; European Research Council ; Fondo de Investigaciones Sanitarias, Spain ; CIBER de Enfermedades Raras of the Instituto de Salud Carlos III, Spain ; Fondo Europeo de Desarrollo Regional (FEDER), Union Europea, Una manera de hacer Europa ; Catalan Government, Spain ; Fundacio La Marato de TV3, Catalonia, Spain ; Italian Association for Cancer research (AIRC) ; Italian Ministry of Health ; Programme Hospitalier de Recherche Clinique ; Institut National du Cancer (INCA) ; Comision Honoraria de Lucha Contra el Cancer, Montevideo, Uruguay ; Dutch Cancer Society ; CONACYT, Mexico ; NHMRC ; Cancer Institute NSW ; National Institutes of Health ; Texas A&M Hlth Sci Ctr, Dept Epidemiol & Biostat, College Stn, TX USA ; Univ Penn, Dept Biostat & Epidemiol, Philadelphia, PA USA ; Natl Canc Inst, Div Canc Epidemiol & Genet, Human Genet Program, Bethesda, MD USA ; Hop Cochin, AP HP, Paris, France ; Univ Paris 05, Paris, France ; Tel Aviv Univ, Sackler Fac Med, Sheba Med Ctr, Dept Dermatol, Tel Aviv, Israel ; Leiden Univ, Med Ctr, Dept Dermatol, Leiden, Netherlands ; St James Univ Hosp, Canc Res UK Clin Ctr Leeds, Leeds Inst Canc & Pathol, Sect Epidemiol & Biostat, Leeds, W Yorkshire, England ; 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National Health and Medical Research Council of Australia: NHMRC 107359 ; National Health and Medical Research Council of Australia: 402761 ; National Health and Medical Research Council of Australia: 633004 ; National Health and Medical Research Council of Australia: 566946 ; National Health and Medical Research Council of Australia: 211172 ; Cancer Council New South Wales: 77/00 ; Cancer Council New South Wales: 06/10 ; Cancer Institute New South Wales: CINSW 05/TPG/1-01 ; |Cancer Institute New South Wales: 10/TPG/1-02 ; Cancer Council Queensland: 371 ; FAPESP: 2007/04313-2 ; NCI: CA88363 ; European Research Council: ERC-2011-294576 ; Fondo de Investigaciones Sanitarias, Spain: P.I. 09/01393 ; Fondo de Investigaciones Sanitarias, Spain: P.I. 12/ 00840 ; Catalan Government, Spain: AGAUR 2009 SGR 1337 ; Catalan Government, Spain: AGAUR 2014_SGR_603 ; Fundacio La Marato de TV3, Catalonia, Spain: 201331-30 ; Italian Association for Cancer research (AIRC): 15460 ; Programme Hospitalier de Recherche Clinique: PHRC-AOM-07-195 ; 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