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A reform as a lever for innovation and professionalism?
Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare.ORCID-id: 0000-0001-6784-0133
Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Högskolan i Jönköping, Hälsohögskolan, HHJ, Institutet för gerontologi. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.ORCID-id: 0000-0001-8952-8773
University of Gothenburg.
2017 (Engelska)Konferensbidrag, Enbart muntlig presentation (Refereegranskat)
Abstract [en]

Introduction: Consistently with international trends, managerial reforms and incentive systems in Sweden have been introduced to achieve quality improvement and increased efficiency in welfare services. Evidence suggests that targeted financial micro-incentives can stimulate change in certain areas of care, but they do not result in more radical change, such as service transformations or innovation.

Aim: In this study we explore how organizational performance are changing within the context of a patient choice reform in primary healthcare.

Material and Methods: This qualitative study is based on 48 semi-structured interviews with various professions (managers, physicians, nurses, physical- and occupational therapists, care administrators, and nurse assistants) at five PHCCs, conducted as part of a study designed to explore financial incentives and motivation in PHC in Sweden. The PHCCs were purposively selected to ensure the inclusion of both public and private facilities. All centers had a longstanding reputation for good leadership and high quality care. 

Results: The findings show how professional fields and traits were dissolving and changing, triggering the emergence of innovative solutions in practice. Through ongoing negotiations of professional boundaries new practices unfolded and professionalism increasingly was achieved through contextual conditions. The expanding and changing of professional boundaries as shown in the study are implied to stimulate innovative processes. Thus, the main findings suggest that innovative practices developed as a relationship between contextual conditions and professionalism. E.g. nurses and physical therapists remitted patients directly to the hospital, multiprofessional teams for patient groups with joint needs handled patients that previous needed hospital care, and nurse assistants became responsible for summing patients with minor hypertension for blood pressure controls and consultations.

Conclusions: The reform seemed to act as a lever for innovation and professionalism under certain conditions. How work is organized and managed is a contextual factor that not only affects work circumstances, but also provides conditions for innovation and professionalism. Impartial to governments’ ambitions to improve their responsiveness to the needs of citizens by altering market rules, new provider models may be of little assistance in achieving the desired effect on health sector reform outcomes if suitable contextual conditions are missing.

Ort, förlag, år, upplaga, sidor
2017.
Nationell ämneskategori
Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi
Identifikatorer
URN: urn:nbn:se:hj:diva-38454OAI: oai:DiVA.org:hj-38454DiVA, id: diva2:1172923
Konferens
NOVO 11th Symposium, “Measures to meet Nordic challenges for sustainable health care organizations”, 9-10 November 2017, Gothenburg, Sweden
Anmärkning

Nordiska ministerrådets nätverk

Tillgänglig från: 2018-01-11 Skapad: 2018-01-11 Senast uppdaterad: 2018-01-15Bibliografiskt granskad

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Avby, GunillaKjellström, Sofia

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The Jönköping Academy for Improvement of Health and WelfareHHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare)HHJ, Institutet för gerontologiHHJ. ADULT
Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi

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