According to me, as a Swede, vulnerable and especially vulnerability is kind of difficult to pronounce. It´s like there´s too many vowels way back in my throat… I have to concentrate hard to get it right. The last days I´ve been concentrating hard, really hard. My first deadline was today and in agreement with my supervisors I have sent my revised project plan to them. I will get my feedback when we meet Thursday afternoon. Yesterday a feeling of fear emerged into my consciousness, fear of showing my weaknesses and flaws to three supervisors that I look up to, respect and admire. A fear that almost paralyzed my intellectual capabilities. A fear which had power of my thoughts and made me feel inferior and fragile. After a sleepless night and hours of brooding I´ve come to the conclusion that in order to improve my academic skills I have to accept the process of uncover myself to my supervisors. There will no longer be any doubts of which level my critical thinking is at. That is the price I have to pay for expose my capacity and abilities. In some ways I´m terrified to show this manifestation of competence (worst case scenario – incompetence) but I also think that I have to embrace the adeptness and just lay myself bare and show my stomach in order to get better. You know, like dogs do, totally unabashed by the position their in. Only, unlike the dogs, I´m utterly embarrassed by my posture. Nevertheless, it is what it is, no harm done – yet – I have to trust my supervisors and I am grateful for their feedback! The response will make me grow and improve. After all I´m here to germinate.

Ambition for the rest of the day: To endeavor a jaunty walk into the sunset!


Photos: Pixabay

Cognitive process

Sometimes it helps to make a bad joke out of those odd moments in life. At the interview (when I applied to become a PhD student) one associate professor asked me a question and it has haunt me ever since.



Also me: OMG, I don´t even understand the question!

But I do have questions – lots of them…

  • What is so special about this specific group of patients that I want to study?
  • How does their experiences differ from other group with similar preparations?
  • Why is this research important and what is the future value?
  • …and so on…into infinity.

Before the summer I agreed with my supervisors to study the subject gastroenterology in-depth so that I would have the prerequisite skills to enhance my research project when I see them in one week from now and here I am making memes… Back to finding focus and answers!

Photo: Pixabay


Six dimensions

According to the report “Crossing the quality chasm” from 2001, there are six dimensions of quality. These dimensions represent characteristics of how health care should be and what areas to focus on when improving it.

  • Safe – make no harm
  • Effective – evidence-based care
  • Patient-centered – individual responsive and respectful care
  • Timely – access and system responsiveness
  • Efficient – cost effectiveness
  • Equitable – same quality to everyone

I think that Jessica Uriarte makes the six dimensions understandable in her excellent video.

In the video Jessica talks about how to honor the patients´experiences and that all care must be align with their goals and values. Not unexpectedly that is in line with what the report Crossing the Quality Chasm has declared:

“Patient-centered encompasses qualities of compassion, empathy,
and responsiveness to the needs, values, and expressed preferences of the
individual patient.”

Health care should focus on adapted care that is flexible and aware of the specific needs of individuals to provide patient-centeredness.

Quality improvement is a process of continually evaluating clinical practices using patient outcomes as the basis of evaluation. Berwick (2002) argues for patients’ outcomes as the fundamental source of defining quality. By ignoring the patients´experiences and perceptions we could end up with a care that is inhuman, out of compassion and empathy. Instead we should honor the patients´ needs and take their goals and values into account when striving towards high-quality care.

I believe that the core in my forthcoming research will be to highlight the patients perspective. To put it in a nutshell, it seems to be impossible to conduct high-quality endoscopic procedures without taking the patients´ experiences into account.

Berwick D (2002) A User’s Manual for the IOM’s Quality Chasm Report. Health Aff (Millwood), 21(3), 80-90.

Institute of Medicine (2001) Crossing the Quality Chasm: A New Health System for the Twenty-first Century. Washington, National Academy Press.

Uriarte J (2015) 6 dimensions of Healthcare Quality


From good to great

Oh dear, what have I done? Today´s lesson is nothing less than an understanding of the impossible thing I´m about to do. How on earth am I going to measure patient satisfaction during endoscopic procedures? My ambition is to achieve a standard for measuring patient satisfaction in the name of quality assurance and by that create a tool for quality improvement.

Fred Lee in this TEDx talk is excellent and fun when he describes an experience of taking a blood sample. (Let me get this straight – I don´t fancy Fred Lee´s old fashion description of him being a manly male and us being female nurses categorized into gentle vs. rough but if you see beyond that I totally get his point.) So this is how it goes, at first he meet “the good nurse” rough Rudy who concentrates on her task and accomplish it without any vital errors. Afterwards he describes another encounter with “the great nurse” gentle Cherie. She mastered the task of taking a blood sample in a different more compassionate way, where she cared for the person in front of her. The patient, Mr Lee´s perception of the two meetings was an example of how good went into great and of course he want caring gentle Cherie to come for tomorrow mornings blood sample.

He also makes an comparison with a trip to Disney world… it was good but not fun. Guess we all want a trip to Disney world to be more than good and, if I´ve understood the point of this video, we in the health care business ought to think the same. Our patients are supposed to experience something satisfying in their encounter with us.


The father of quality – Edward Deming – is quoted in the video:

If you can´t measure it, you can´t improve it. But, the most important figures one needs for management are unknown and unknowable.

The question of how do you measure the effort of going from good to great in patient perceptions still remains and that will be my headache for eight looong years 😉

Photo: Pixabay

Today’s lesson

Today I´ve learned about quality improvement in health care. It all started with the desire to answer the questions: What is patient satisfaction and why does it matters? One thing led to another and as I started my search I went back in time, way back to 1966, where I met Avedis Donabedian (1919-2000). Apparently, he is the father of the leading paradigm quality framework, which I am quite familiar with. The framework who describes the dimensions of care in; structure, process and outcome. The structure is described as the staff, the access and the equipment, while the process is the action, for example diagnosis and treatment. Finally, the outcome reports about the result, which can be both objective or subjective, as well as individual or group wise. Donabedian advise researchers to use the question -What goes on here?  rather then -What is wrong and how can we do better? I think that can be a great suggestion and a healthy reminder to take into account when I design my research questions. Also inspired by David Feinberg and his UCTV-talk about patient experience where he simply asked patients at the UCLA hospital using the question -How is the care? I believe that an open mind and a spirit of inquiry must be the best approach to explore the endoscopic care process and the patients experiences of it.

Donabedian A (2005) Evaluating the Quality of Medical Care. The Milbank Quarterly, 83 (4), 691–729. Milbank Memorial Fund, Blackwell Publishing.

Feinberg D (2012) Quality Improvement and Healthcare Reform: Patient Experience with David Feinberg. University of California Television(UCTV). 

Photo: Pixabay

I am about to do…

Yet another short and quick blog post. Some of you have asked what my research subject is. Confessedly, I have to say that I will not do my PhD on pedagogy, digital media or anything that has to do with what I actually know something about. Two weeks before application due day I had a talk to my professor and it ended out in an email to the Endoscopy Unit at Skåne University Hospital, Malmö, Sweden (where I´ve been working in the summer breaks). I simply asked if they might be interested in having me as a PhD student and that my research proposal was about quality assurance of patient satisfaction during endoscopic procedure. Within 40 minutes I had an extremely encouraging and benevolent positive answer from both the head and the manager of the unit. The air of propitiousness made me believe in my own ability, and without thinking too much, I dived in with such a delight and joy, reading, writing and learning about my new subject. So, this is where I stand now… Accepted for third cycle studies (about to start in two weeks), the feeling of knowing absolutely nothing and just… you know… puddle and splashing around trying to figure out where to start.

Reminder to myself: Proceed as if limits to your ability do not exist!


Promise to myself

On my honour I promise that I refuse to be dwarfed by others brightness. Throughout this journey I will follow my own path. No matter how small my achievements are, I will be proud of my progress and I will continue to strive forward.


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