Published: 03-10-2018 12:57 | Updated: 21-07-2020 15:48

The research group SOLIID at MMC receives project grant from FORTE!

The project "LST-STRATEGY – Strategies for large system transformations in a decentralized healthcare system" led by Monica Nyström at the Department of Learning, Informatics, Management and Ethics, MMC/SOLIID, receives funding from FORTE, the Swedish Research Council for Health, Working Life and Welfare.

Inequities in health related to social, economic and geographical factors, including inequities in the access to health and social services are important issues on the political agenda today. Governmental investments to improve healthcare are substantial and take the form of comprehensive policies.

It is important to learn from implementation and change processes and from more or less successful strategies used in such complex interventions. The large-system transformations (LST) aimed for are coordinated, system-wide change affecting multiple organizations and care providers, with the goal of significant improvement in efficiency of health care delivery, quality of patient care and population-level patient outcomes.

Many studies of improvement in healthcare focus on microsystems level and on small-scale change initiatives involving a few organizations or single strategies, while empirical studies of LSTs are relatively sparse. Implementing change in complex adaptive systems requires constant monitoring and adaptation to new contexts. Such interventions are challenging to lead and implement – and process evaluations that can shed light on how this task is approached are often missing.

Knowledge in this area can increase the intended impact of national interventions and make resources spent more valuable.

The purpose of this project is to compare the strategies used in the implementation of 3 national programs in order to make sustainable impact on health and healthcare services provided by county councils, municipalities and private organizations and address the impact of these strategies.

The programs involve complex interventions, national quality registries, and target complex contexts where interventions have to adapt to dynamic local conditions for change to occur and be sustainable.

The design is a comparative, longitudinal multiple case study with a mixed methods approach. It consists of 3 sub-studies based on interviews, observations, questionnaires, documents, program-evaluations, and registry data. The analyses will be guided by recently proposed frameworks for LSTs.

A comparison among the programs has a big potential to contribute to both research and practices and eventually to improve health and social care, citizens health and reduce inequalities.

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Monica Nyström

Senior Lecturer


Monica Nyström Senior Lecturer