Morten Sager
Senior Lecturer
Linguistics and Theory of Science unitAbout Morten Sager
As an Associate Professor and Senior Lecturer, I am continuously engaged in both research and teaching. At present, my main pedagogical responsibility is the master’s programme in evidence-based practice, which targets both newly graduated students and practising professionals within healthcare, social services, and education.
Research
My research has focused on how new knowledge is produced and how it contributes to the design of the welfare state within medicine, social services, and public health.
Since my doctoral dissertation on stem cell research, I have conducted research on evidence-based medicine, standards within the sickness insurance system, and historical as well as contemporary challenges in public health, such as vaccination programmes, suicide prevention, prevention of violent extremism, and problems associated with alcohol, narcotics, doping, and tobacco (ANDT). My most recent project as a PI concerned knowledge in the social services.
Knowledge Support in Social Services
By following several organisations within Bräcke Diakoni, a group of researchers and I seek to understand the role that knowledge support can play in social services. A key premise is that research-based knowledge needs to interact with the expertise of professionals and service users. The question is how different forms of knowledge can meet in ways that support practice. Another hypothesis is that standardisation cannot function without assessment-based knowledge and sensitivity to the local context playing a significant role. For this reason, we conduct in-depth studies of local practices through participant observation and interviews. Based on this work, we develop different formats of knowledge support in collaboration with practitioners.
Systematic Reviews of Preventive Interventions
Systematic reviews are conducted according to explicit principles for literature search, inclusion, quality appraisal, and synthesis of study results. The aim is to provide a comprehensive overview of a field and assess the significance of existing studies for a given research question. In projects I have led on behalf of the Public Health Agency of Sweden, research teams have compiled all available literature on educational and awareness-raising interventions to prevent suicide, as well as interventions aimed at preventing problems associated with the use and misuse of alcohol, narcotics, doping, and tobacco. In a project for the Segerstedt Institute, we similarly compiled all research on interventions to prevent recruitment into violent extremism. The results of these systematic reviews show that research has so far been unable to demonstrate any clear-cut effects of the interventions studied.
Challenges in Vaccination Programmes
I participated in the final phase of a research project on antibiotic resistance and vaccination programmes funded by the Swedish Research Council. The project was led by Margareta Hallberg (principal investigator) and Fredrik Bragesjö. One challenge I addressed in the project concerns how large-scale—and sometimes very rapidly implemented—vaccination programmes can maintain broad public credibility in the face of uncertainty, social anxiety, and divided expert opinion. As I have shown in my contribution to Socialmedicinsk tidskrift (no. 9, 2015), it is important to have a realistic understanding of scientific uncertainty in order to avoid unnecessary blame. At the same time, there is a need to recognise that occasionally exaggerated expectations are part of the mobilisation of resources.
The New Sickness Insurance System
How does the new sickness insurance system function? This question has been addressed in a multidisciplinary group of social medicine researchers from Sahlgrenska Academy and scholars in philosophy of science. The study examines how standardised guidelines for sickness absence duration have been established and implemented in everyday medical practice. A key institutional change has been the collaboration between the Swedish Social Insurance Agency and healthcare services through the “Decision Support for Insurance Medicine Guidelines” (BFR), which contains standardised assessments of sickness absence length for different diagnoses. BFR is used by physicians, case officers at the Social Insurance Agency, and insurance medicine advisors, with the aim of achieving a more uniform sickness certification process. Lena Eriksson and I have shown (among other outlets in Evidence & Policy, no. 3, 2015) that the focus on work ability has led to a substantial transformation of practice, while the format and development of the decision support system have clashed with the limited knowledge available about the phenomenon of work ability itself. This project was funded by the Social Insurance Agency and conducted in collaboration with the Unit of Social Medicine at Sahlgrenska Academy.
Evidence-Based Medicine
Between 2006 and 2010, I was involved in a research project on evidence-based medicine together with Ingemar Bohlin. Overall, the project examined how evidence-based medicine (EBM) emerged and became established during the final decades of the twentieth century, and how the concept has been implemented in Swedish healthcare. One outcome of the project was the edited volume Evidensens många ansikten (The Many Faces of Evidence), published in spring 2011 by Arkiv Förlag in the Pandora series, with Bohlin and myself as editors.
In the project, we identified and analysed the assumptions about objectivity and reliability on which evidence-based methodology rests.
Bohlin studied the path from individual studies—such as randomised controlled trials (RCTs)—to general syntheses of reliable evidence. One of Bohlin’s key contributions, published in Evidensens många ansikten, concerned the diversity that characterised the origins of the evidence-based movement. At least four historical developments preceded and shaped the movement: the outcomes movement, clinical epidemiology, meta-analysis, and RCT methodology. These developments generated tensions that continue to influence how different actors understand evidence-based medicine today. In my own research on guideline implementation, these tensions are highly visible among actors at multiple levels.
My part of the project addressed the movement from general guidelines back to individual cases, with a focus on Swedish cardiac care. I followed this process across several levels, from SBU and the National Board of Health and Welfare, through county and regional politicians, hospital management and department heads, to practising physicians. The intended effects of initiatives launched at the highest level often—but not always—fail to materialise at the clinical level. Differences in actors’ assumptions could be traced back to the historical development paths identified by Bohlin. More specifically, I showed how administrators and guidelines from the National Board of Health and Welfare focused on a criterion typical of the outcomes movement, namely relevance, while clinical cardiologists and SBU emphasised the methodological rigour associated with meta-analyses and RCTs. These tensions contributed to disagreements over the pace at which two new device-based treatments for the prevention of cardiac arrest should be introduced.
Doctoral Dissertation on Stem Cells
In my doctoral dissertation, I examined how different actors’ relationships to stem cell research in the United States can be understood using actor–network theory (ANT).
Education and Teaching
As a result of my research, I have had the opportunity to develop the master’s programme in evidence-based practice, which was launched in autumn 2013. In this role, I also draw on my teaching experience from both natural science master’s programmes and various healthcare education programmes, such as the medical programme and the public health science programme at Sahlgrenska Academy.
Master’s Programme in Evidence-Based Practice
The programme is designed to address a need experienced by many actors in government agencies, municipalities, and regional authorities concerning evidence:
What techniques exist for identifying knowledge that is useful in welfare sector practices?
How do knowledge models differ between the professions commonly working in healthcare, social services, and education?
What happens when different professional perspectives on evidence meet?
How can an organisation make use of knowledge from research and evaluation, practitioners, and service users?
How should lack of knowledge be managed?
What ethical problems and methodological weaknesses exist—for individuals, organisations, and society?
The programme has been developed in collaboration with numerous departments and faculties at the University of Gothenburg, as well as several external partners active in the evidence field, including the Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU), the National Board of Health and Welfare, the Gothenburg Region Association of Local Authorities, the Västra Götaland Regional Office, the Competence Council for Psychologists, the HTA unit at Sahlgrenska University Hospital, and the academic think tank Leading Health Care.
Special Areas of Teaching
Based on my doctoral dissertation on stem cell research, I have given numerous lectures on the societal and ethical implications of stem cell research at Chalmers University of Technology and at Sahlgrenska Academy.
In recent years, my focus has been on healthcare education, and particularly on evidence-based practice. I have taught in doctoral programmes at the Vårdal Institute and Sahlgrenska Academy, as well as to students training to become physicians, public health scientists, dental technicians, dental hygienists, speech and language therapists, audiologists, occupational therapists, and physiotherapists.
Collaboration
One of my main tasks in interactions with government agencies and regional actors in healthcare, social services, education, and public health is to contribute to reflection on how knowledge can be produced and used within different forms of practice.