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Nina Ingemann Christensen,1 Sabina Drejer,1 Karin Burns,2,3 Sanne Lykke Lundstrøm,2 Nana Folmann Hempler1 1Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark; 2Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark; 3Department of Endocrinology and Cardiology, Copenhagen University Hospital, Hvidovre, DenmarkCorrespondence: Nana Folmann Hempler Tel +45 40 732 591Email Nana.folmann.hempler@regionh.dkBackground: Enhancing diabetes self-management (DSM) in patients with type 2 diabetes (T2D) can reduce the risk of complications, enhance healthier lifestyles, and improve quality of life. Furthermore, vulnerable groups struggle more with DSM.Aim: To explore barriers and facilitators related to DSM in vulnerable groups through the perspectives of patients with T2D and healthcare professionals (HCPs).Methods: Data were collected through three interactive workshops with Danish-speaking patients with T2D (n=6), Urdu-speaking patients with T2D (n=6), and HCPs (n=16) and analyzed using systematic text condensation.Results: The following barriers to DSM were found among members of vulnerable groups with T2D: 1) lack of access to DSM support, 2) interference and judgment from one’s social environment, and 3) feeling powerless or helpless. The following factors facilitated DSM among vulnerable persons with T2D: 1) a person-centered approach, 2) peer support, and 3) practical and concrete knowledge about DSM. Several barriers and facilitators expressed by persons with T2D, particularly those who spoke Danish, were also expressed by HCPs.Conclusion: Vulnerable patients with T2D preferred individualized and practice-based education tailored to their needs. More attention should be paid to training HCPs to handle feelings of helplessness and lack of motivation among vulnerable groups, particularly among ethnic minority patients, and to tailor care to ethnic minorities.Keywords: diabetes self-management, type 2 diabetes, vulnerable target groups, ethnic minorities, health inequities, socially disadvantaged population

Background Research shows that many people with cardiac disease decline cardiac rehabilitation. There is little or no knowledge on how health professionals respond to these people. Objectives To investigate how nurses respond to people who do not wish to participate in cardiac rehabilitation and what influences the nurses´ approach towards these people. Design A qualitative study involving interviews and video-recordings using an analysis inspired by ethnographic principles and categorisation theory. Setting A rehabilitation clinic at a large hospital in the Capital Region of Denmark. Participants Five cardiac nurses and 28 people with cardiac disease. Methods We video-recorded the first consultation people with cardiac disease attended regarding cardiac rehabilitation, where the nurses followed up on these people's recovery, medication, lifestyle and need for rehabilitation. We conducted semi-structured interviews with the cardiac nurses. We asked the nurses about the purpose of the first rehabilitation consultation and how they handle people with cardiac disease who say no to rehabilitation. The nurses were shown video-clips with the people they had talked to in their consultation in order to facilitate a dialogue. Results When people with cardiac disease were reluctant to participate in rehabilitation, the nurses made an individual assessment of how much effort to put into motivating them, taking a complex range of factors into account. The effort among the nurses towards people with cardiac disease who decline rehabilitation was smaller in cases when the nurses believed an individual would benefit less from rehabilitation or have difficulty participating. It was important for the nurses to balance their motivational efforts with showing respect for people's autonomy. Conclusion Even when nurses endorse rehabilitation, some people with cardiac disease decline rehabilitation. The nurses' recommendation of the rehabilitation programme is influenced by the knowledge they obtain about the people with cardiac disease during consultations.

Background: During the recent decades, many general practitioners have joined in larger practices with more staff employed. When more people work together within an organisation, the interpersonal relations may affect delivery of services and thereby become valuable for the organisation. ‘Organisational social capital’ is defined as the ability of the members of an organisation to collaborate when solving the key tasks of the organisation, and reflects the interpersonal relations in terms of trust, justice and cooperation skills. How organisational social capital affects services and quality of care in general practice is yet to be documented.Aim: To analyse associations between organisational social capital and patient evaluations of general practice.pital affects services and quality of care in general practice is yet to be documented.Methods: A cross-sectional questionnaire study combining data from two national surveys in general practice in Denmark.The study comprised 136 general practices, 679 healthcare professionals and 17,191 patients. Linear regression was used to explore associations between scores from patients’ evaluations of the quality of general practice care (Danish version of the EUROPEP questionnaire, DanPEP) and organisational social capital measured by the healthcare professionals. The analyses were adjusted for organisational characteristics (organisation form, size of the organisation with regard to the number of healthcare staff and the number of listed patients) and patient characteristics (sex, age, years listed at the present practice, and self-rated health). Results: The level of organisational social capital was positively associated with patients’ evaluations of general practice. The within general practice intraclass correlations of organisational social capital (ICC=26%) and patient evaluations (ICC=5%) were high.Conclusion: In general practice, organisational social capital is positively and statistically significant associated with patient evaluations. Consequently, improving the organisational social capital in general practice may increase patient satisfaction.

Relational coordination rests on the idea that coordination is a central issue in all work and that coordination happens through communication, which in turn is shaped by relations. Relational coordination is quite interesting because it has been shown to correlate with on-time flight departures and surgical performance. This has prompted the attention of both practitioners and politicians some of who perceive relational coordination as a means to attain better performance. The relational coordination instrument has been validated as a measure of teamwork from the following perspectives: internal consistency, interrater agreement and reliability, structural validity, content validity. However as relational coordination is being used as a diagnostics tool it is important to examine further if the instrument can measure changes. Indeed we need to know how precise and sensitive the instrument is when organizations are changed. This paper reports findings from 15 healthcare organizational change projects. The projects received some guidance from external consultants but followed different methodologies and can be considered natural experiments. The projects were measured before and after the change using the relational coordination instrument. Managers were interviewed before the projects and a chronicle workshop (structured group interview) were performed after the project. This design allows us to compare the qualitative descriptions of change in the wards, with the measured change in relational coordination. We distinguish between statistical and clinical significance. Statistical significance is calculated using T-test. Clinical significance is the minimal amount of change in relational coordination score that is not considered noise. Sensitivity of the instrument i.e. the ability of the instrument to measure changes in relational coordination is analysed by evaluating the scope and depth of changes in work processes and relations. Sensitivity of the relational coordination instrument is surprisingly low and event significant changes e.g. introducing a new role in a work process only show small changes in relational coordination scores.

Background. Relational coordination (RC) and organisational social capital (OSC) are measures of novel aspects of an organisation’s performance, which have not previously been analysed together, in general practice. Objectives. The aim of this study was to analyse the associations between RC and OSC, and characteristics of general practice. Methods. Questionnaire survey study comprising 2074 practices in Denmark. Results. General practitioners (GPs) rated both RC and OSC in their general practice higher than their secretaries and nurses. The practice form was statistically significantly associated with high RC and OSC. RC was positively associated with the number of patients listed with a practice per staff, where staff is defined as all members of a practice including both owners and employees. Conclusion. The study showed that RC and OSC were significantly associated with type of profession and practice type. RC was also found to be significantly positively associated with number of patients per staff. However, the low response rate must be taken into consideration when interpreting the self-reported results of this study.

This study presents results from an original empirical study of 11 organizational change projects in different wards at two Danish hospitals. The purpose of the study was to study was to study changes in relation coordination as a consequence of organizational change. We measured relational coordination before and after the organizational change using the 7 question relational coordination questionnaire. A group of employees were interviewed after the change project to uncover the nature and extent of the changes. We find that organizations' relational coordination score change very little – even for organizational change that introduces new work relations and new processes.

In this paper we investigate the association between relational coordination among the practice team in general practice and number of consultations performed in a general practice per staff, i.e. a proxy of productivity. We measured relational coordination using the Relational Coordination Survey and combined the results with register data. We found that relational coordination was statistically significant associated with number of consultation per staff per year. We later divided consultations in to three types: Face-to-face, Email and phone consultations. We found a statistically significant associating between relational coordination and with number of face-to-face consultation per staff per year.

Relationel koordinering har tiltrukket sig betydelig opmærksomhed på sundhedsområdet. Relationel koordinering appellerer til både det medicinskfaglige perspektiv og arbejdslivsperspektivet, idet relationel koordinering tilbyder en teori og et måleredskab, der kan afdække produktivitet, behandlingskvalitet og trivsel på samme tid. Dette er ideelt i forbindelse med organisatorisk forandring, da man med udgangspunkt i relationel koordinering-og arbejde med relationer og kommunikation i arbejdet-vil kunne øge både trivsel og kvaliteten i arbejdet. Denne artikel rejser spørgsmålet om, det gennem et forandringsprojekt reelt er muligt at måle ændringer i samarbejde og relationer. Artiklen belyser teorien og præsenterer data fra 11 forandringsprojekter, som udviser meget små ændringer i relationel koordinering. Ændringerne står i kontrast til interviews i projekterne, som peger på betydelige ændringer i samarbejde og relationer. Det er dermed tvivlsomt, hvad måling af relationel koordinering faktisk betyder, og disse målinger skal dermed behandles med varsomhed i konkrete forandringsaktiviteter.