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- Sandberg, Johanna, 1981-
(författare)
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Institutionally Shaped Response to the Introduction of National Guidelines : Case Studies in the Swedish Regional Health Policy Arena
- 2018
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The purpose of this thesis is to explore the institutionally shaped response to the introduction of the national guidelines on the Swedish regional health policy arena. The thesis consists of two case studies. Adapting a qualitative approach, the data is based on individual interviews and these were analysed thematically. The first paper explores the response by four Swedish regional health authorities to the introduction of the National Guidelines for Cardiac Care, while the second paper aims to broaden the understanding of how the national guidelines are used for strategic purposes among politicians.As illustrated in this thesis, organizations will respond, adjust and react to external pressure according to conditions shaped by the institutional context. Key findings here are that the national guidelines are a complex policy instrument that, beyond being able to be used in an instrumental fashion by the medical managment, can also serve a legitimizing function for political decision-makers.The goals of the national guidelines, i.e. equal and efficient care, and the uncertainty about who, among multiple stakeholders, is responsible for the guidelines in the regional health authority, is a source of ambiguity and potential conflict. Those who are potentially responsible represent different rationales – a political rationale and a scientific rationale. The dominating scientific rationale of the national guidelines can create instability, when pushing towards the use of explicit priority-setting.Priority-setting in the institutional setting of a regional health authority has strong elements of becoming “wicked problems” since the dilemma of prioritization remains regardless of ambitions to apply a “technocratic fix”. A wicked problem is characterized by high complexity and being persistently hard to solve (Williams et al. 2012). A recurring dilemma is that priority-setting still contains many wicked problems, as social values and political considerations remain important parts of the policy process. One weakness of the national guidelines, identified in this thesis, is that the guidelines discuss each service area separately, and thereby reinforce a silo mentality in the Swedish health policy arena.To sum up, the national guidelines create a multifaceted and complex response in the Swedish health policy arena where different rationalities collide, and where conflicts appear and are dealt with within the regional health authorities.
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| 2. |
- Gustafsson, Mariana S., 1978-
(författare)
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Reassembling Local E-Government : A study of actors’ translations of digitalisation in public administration
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The digitalisation of society decidedly affects public administration. Swedish public administration has long worked with information technologies for an effective and improved management of public services. But new and increased use of information technologies in society poses new challenges. New demands on information security are increasing, while accessibility and transparency are important priorities in policies on digitalisation in public services. However, the central government’s ambitions and expectations with regard to digitalisation face a slow and hesitant implementation in local governments. There are important differences between municipalities in priorities, local needs, and implementation mechanisms in connection with e-government. In this thesis, I argue there is a need to reconsider the role of governance mechanisms in e-government. There is a need to understand local translations of national policies and technological developments in relation to the goals of more effective and legitimate public administration. The main purpose of this thesis is to analyse tensions that emerge in the implementation of egovernment in local public administration. On the basis of a constructivist and interpretivist approach, I have undertaken two empirical studies. One focuses on municipal administration of education in Linköping. The other focuses on a governance network on digitalisation policy in Östergötland. The studies are presented in four papers. The issues addressed in the papers are further analysed with a focus on four fields of tension, using network governance theory and translation theory. This shows that the implementation of e-government in local public administration is a tension-laden process. The four fields of tension relate to: different logics and dilemmas for adoption and implementation; concerns and ambiguities in a context of unclear organisational and institutional arrangements; concerns and resistance from professional users; and a reassessment of the meaning of security as a reference for the interpretation of information security. I contend that established managerial and evolutionary models of e-government leave important process-related aspects out of the analysis of change in public administration. The contribution of this thesis lies in its description and analysis of the four identified fields of tension. One significant implication of my analysis is that reassembling current governance mechanisms in local public administration is crucial.
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