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What frames Quality Registers in Swedish Health Care: an institutional approach
Linköping University, Department of Management and Engineering, Political Science. Linköping University, Faculty of Arts and Sciences.ORCID iD: 0000-0001-6803-7414
2011 (English)In: Proceedings from 14th Uddevalla Symposium, 2011 Entrepreneurial Knowledge, Technology and Transformation of Regions / [ed] Iréne Bernhard, Linköping: Linköping University Electronic Press, 2011, 1-19 p.Conference paper (Other academic)
Abstract [en]

Quality issues strike the classical conflict in a democratic health-care deliverysystem of different interests among the politicians, the medical profession andpublic officials. This cannot be studied as a cut-off whiz. Quality registers havedeveloped over the past 40 years. Therefore, this paper puts the innovation ofquality registers in an institutional perspective. Two things are essential in thispaper. First, this paper reviews the emergence of quality registers in Swedish healthcare as an effect of institutional arrangements. Second, it analyses the interactionof diverse factors in different institutional settings and logics. The relevant data forthe study was collected from official/unofficial policy documents and key actorinterviews.The empirical findings show that three different waves of development can betraced in history that has highly affected the development of quality registers. Italso shows that medical quality is framed and determined by physicians in line withprofessional knowledge and by the primary institutional logic of quality in medicalcare. However, organisational quality in health care is framed by the logic ofpublic equity of access based on a third party payer and the logic of managerialcontrol. These two paths of quality developments are now federating in aninstitutional logic of transparency. The contribution of this paper is importantbecause it produces insights in different institutional logics, which frames the riseof the two quality paths and the problems they have to face in order to merge. It also enhances the existing knowledge that institutions matter.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2011. 1-19 p.
, Research Reports 2011:05 University West, ISSN 1653-7831 ; 2011:05
Keyword [en]
health care, institutional change, quality, innovation
National Category
Public Administration Studies
URN: urn:nbn:se:liu:diva-88746ISBN: 978-91-977943-2-9OAI: diva2:606043
14th Uddevalla Symposium, 2011 Entrepreneurial Knowledge, Technology and Transformation of Regions, June 16-18, Bergamo, Italy
Available from: 2013-02-19 Created: 2013-02-18 Last updated: 2016-08-31Bibliographically approved
In thesis
1. Mellan kunskap och politik: Kvalitetssystem och offentlig kunskapsstyrning i hälso- och sjukvården
Open this publication in new window or tab >>Mellan kunskap och politik: Kvalitetssystem och offentlig kunskapsstyrning i hälso- och sjukvården
2016 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[en]
Between knowledge and politics : Quality management systems and public knowledge management in healthcare
Abstract [sv]

Syftet med den här avhandlingen är att undersöka utvecklingen av kvalitetssystem i hälso- och sjukvården ur ett historiskt-institutionellt perspektiv utifrån fallstudier och konceptuella analyser. Särskilt analyseras implikationer av utvecklingen med avseende på relationen mellan den medicinska professionen och det politiskt administrativa systemet samt konsekvenser för den politiska styrningen av sjukvården.

Studien visar att medicinska kvalitetssystem och därmed även den medicinska professionen bäddats in i den politiska styrningen i takt med att ambitionerna mot en offentlig kunskapsstyrning tilltagit. Den visar även att hälso- och sjukvårdens kvalitetsregister i olika faser av sin utveckling har påverkats av politiska ideologier, managementidéer och idéer om transparens. Öppna jämförelser som en oavsiktlig konsekvens av kvalitetsregisteranvändningen förstärker dessutom tendensen mot en offentlig kunskapsstyrning.

Av studien framgår också att den offentliga kunskapsstyrningen utmanar föreställningen om demokratiidealet om upplyst förståelse. Den ökade fokuseringen på kunskapsstyrning inom hälso- och sjukvården gör det relevant att ställa frågan vem som styr vem i svensk hälso- och sjukvård, vilket i sig är en fråga om demokrati och legitimitet.

Abstract [en]

The aim with this thesis is to describe the quality development in Swedish healthcare from an institutional perspective, analyse implications of the development concerning the relationship between the medical profession and the public administrative system and discuss consequences for political direction and welfare organization. The study is based on four case studies and one conceptual analysis.

The main conclusion is that the medical quality systems have been imbedded in the political management alongside the development towards a public knowledge management. The analysis has more specifically uncovered that quality registries in healthcare have been influenced by political ideologies, management ideas and ideas of transparency. It is also clear that open comparisons were an ‘unintended consequence’ of the quality registry development that has enhanced the development towards a public knowledge management.

The analysis also shows that public knowledge management challenges the ideal of democratic enlightened understanding. The development of public knowledge management in the healthcare sector raises the question of who is governing whom in Swedish healthcare.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2016. 81 p.
Linköping Studies in Arts and Science, ISSN 0282-9800 ; 690
Offentlig förvaltning, hälso- och sjukvårdspolitik, historisk institutionalism, kvalitetsstyrning, kunskapsstyrning, Public administration, healthcare politics, historical institutionalism, quality management, knowledge management
National Category
Public Administration Studies Information Systems, Social aspects Social Sciences Interdisciplinary
urn:nbn:se:liu:diva-130924 (URN)10.3384/diss.diva-130924 (DOI)9789176857199 (Print) (ISBN)
Public defence
2016-09-29, ACAS, Hus A, Campus Valla, Linköping, 13:15 (Swedish)
Available from: 2016-08-31 Created: 2016-08-31 Last updated: 2016-09-06Bibliographically approved

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