21.
Rudenstam, Nils-Gunnar, 1950-, et al.
(författare)
Inter-organizational cooperation : a rehabilitation project based on cooperation between health care and three social service agencies
2014
Ingår i: Health. - 1949-4998 .- 1949-5005. ; 6:5, s. 342-349
Tidskriftsartikel (refereegranskat) abstract
Purpose: Cooperation between organizations is an often-suggested remedy for handling unsolved borderland problems. However, actual projects aiming at cooperation are seldom very successful. The purpose here is to highlight obstacles related to cooperation between different organizations based on a case study of a rehabilitation project where health care and several social service organizations (social insurance, social welfare, and the local employment agency) were involved. Data were gathered through participation and interviews. Findings: It seems that efficient cooperation requires an understanding of the participating organizations’ differences in work logic as well as work practices. Furthermore, only certain fairly standardized “normal” problems may be handled through organized cooperation while non-routine exceptional problem requires a more fully integrated work organization. Implications: Obstacles to cooperation are highlighted and ways to improve the possibilities of cooperation between organizations are suggested although such possibilities are generally hampered by differences in work logic.
22.
Willumsen, Elisabeth, et al.
(författare)
A conceptual framework for assessing interorganizational integration and interprofessional collaboration
2012
Ingår i: Journal of Interprofessional Care. - 1356-1820 .- 1469-9567. ; 26:3, s. 198-204
Tidskriftsartikel (refereegranskat) abstract
The need for collaboration in health and social welfare is well documented internationally. It is related to the improvement of services for the users, particularly target groups with multiple problems. However, there is still insufficient knowledge of the complex area of collaboration, and the interprofessional literature highlights the need to develop adequate research approaches for exploring collaboration between organizations, professionals and service users. This paper proposes a conceptual framework based on interorganizational and interprofessional research, with focus on the concepts of integration and collaboration. Furthermore, the paper suggests how two measurement instruments can be combined and adapted to the welfare context in order to explore collaboration between organizations, professionals and service users, thereby contributing to knowledge development and policy improvement. Issues concerning reliability, validity and design alternatives, as well as the importance of management, clinical implications and service user involvement in future research, are discussed.
23.
Åhgren, Bengt
(författare)
Competition and integration in Swedish health care
2010
Ingår i: Health Policy. - 0168-8510 .- 1872-6054. ; 96:2, s. 91-97
Tidskriftsartikel (refereegranskat) abstract
Despite of an insignificant track record of quasi-market models in Sweden, new models of this kind have recently been introduced in health care; commonly referred to as "choice of care". This time citizens act as purchasers; choosing the primary care centre or family physician they want to be treated by, which, in turn, generates a capitation payment to the chosen unit. Policy makers believe that such systems will be self-remedial, that is, as a result of competition the strong providers survive while unprofitable ones will be eliminated. Because of negative consequences of the fragmented health care delivery, policy makers at the same time also promote different forms of integrated health care arrangements. One example is "local health care", which could be described as an upgraded community-oriented primary care, supported by adaptable hospital services, fitting the needs of a local population. This article reviews if it is possible to combine this kind of integrated care system with a competition driven model of governance, or if they are incompatible. The findings indicate that some choice of care schemes could hamper the development of integration in local health care. However, geographical monopolies like local health care, enclosed in a noncompetitive context, lack the stimulus of competition that possibly improves performance. Thus, it could be argued that if choice of care and local health care should be combined, patients ought to choose between integrated health care arrangements and not among individual health professionals. (C) 2010 Elsevier Ireland Ltd. All rights reserved.
24.
Åhgren, Bengt, 1950-
(författare)
Competition-exposed integration : an impossible composition?
2013
Ingår i: What healthcare can we afford?. ; , s. 106-
Konferensbidrag (övrigt vetenskapligt/konstnärligt) abstract
ContextSwedish health care, like many other health care systems, is in a constant development mode to meet never-ending demands for improved efficiency and quality. Competitive and integrative policies are for example concurrently introduced in Swedish primary care; citizens‘ choice of primary care is launched while primary care is expected to integrate its activities with other providers for the creation of =local health care‘. Competition has though a tendency fragment the provision of services. The aim of this study is therefore to explore whether or not these two strategies are compatible in practice.MethodsGroup interviews were conducted at four locations in Sweden. The groups included persons aged between 20 and 45 years, 46 and 64 years and 65 years or over. The interviewees were living either in a big town or in a small community. Altogether, 21 randomly selected individuals participated in the group interviews. A deductive approach was chosen: six question topics were formulated with guidance from a theoretical framework about choice of care. The group interviews were thus semistructured without any predetermined codes. Each group interview took between 1 and 1.5 h to complete. Moreover, the conversations were recorded and transcribed as verbatim reports. As a consequence of the deductive approach, directed content analysis was chosen for the analysis of the group conversations.ResultsChoice of care is executed from the perspectives of being a prospective or current patient, which, in practice, imply choices are performed passive and active respectively. If the later group perceive interpersonal continuity, accessibility and demeanour of health professionals as favourable, they remain faithful to their actively chosen provider. The only condition that seems to trigger this group of patients to reconsider their choices is if they been the subject of bad manners. Those executing passive choices are less faithful to their original choice. When these former prospective patients, often younger persons, are in need of primary care they often disregard their choice if waiting times are shorter at other providers. This group generally prefer accessible service and seldom consider where it is provided. The group of passive choices also include citizens accepting suggestions presented by the authorities, founded on the conviction that ―they know what is best for me.DiscussionMany patients that have made active choices are thus faithful to their choices. This is rare in a consumer-market, which is characterized by high degree of exchangeability of providers; a condition which by and large corresponds with the attitude of those making passive choices. Nevertheless, a majority of patients stay with their choice of provider, often selected among a limited number of options. Moreover, health care providers and patients have long-term relationships, which is typical of a producer-market. In other words, if politicians strive for a competition-exposed primary care, the competition concept ought not to be founded on the theories of a consumer-market. The principles of a producer-market seem instead to be more applicable, which imply that providers will be competitive if they are able to build stable relations with their patients, which, in turn, facilitate for integrative arrangements among health care providers.
25.
Åhgren, Bengt
(författare)
Dissolving the Patient Bermuda Triangle
2010
Ingår i: International Journal of Care Coordination. - 2053-4354. ; 14:4, s. 137-141
Tidskriftsartikel (refereegranskat) abstract
The differentiation of roles, tasks and responsibilities in health care has gradually increased because of efforts to decentralize, specialize and professionalize our health-care systems. These development approaches can on the one hand be regarded as successful, although there is also a negative flipside. Increased differentiation has concurrently fragmented the delivery of health care, which, in turn, can be divided into structural, clinical and cultural fragmentation. Patients are lost as a result of these conditions of fragmentation. This phenomenon can metaphorically be described as a ‘Patient Bermuda Triangle’. Actions to dissolve the Patient Bermuda Triangles are commonly termed ‘Integrated health care’, a global buzzword that includes integrated care pathway as well as other integrated health-care strategies. Moreover, integrated care is a means to an end: improved patient outcome. To achieve this, it is crucial to have necessary prerequisites in place: both functional and interactional conditions. This procedure seems to be an organic process where the stakeholders go through gradual changes until the optimum level of integration, as well as mutualistic interactions, is established. If these conditions are concealed or impossible to achieve, developmental work should be ended to avoid the evolvement of antagonistic relations between the stakeholders concerned. This state will likely establish a Patient Bermuda Triangle or reinforce an existing one.
26.
Åhgren, Bengt, 1950-
(författare)
Health Care Delivery System : Sweden
2014
Ingår i: The Wiley Blackwell Encyclopedia of Health, Illness, Behavior, and Society. - : Wiley-Blackwell. - 1444330764 - 9781444330762 ; , s. 866-872
Bokkapitel (refereegranskat) abstract
In Sweden it is a public sector duty to finance and facilitate the provision of health care. It is thus a “Beveridge” health care system. All residents have accordingly the right to obtain the publicly financed health care. The system is decentralized and includes 21 county councils and 290 municipalities. Furthermore, it rests on a democratic platform: each of these authorities is governed by a parliament, with its representatives elected for a four-year period at every general election.
27.
Åhgren, Bengt, 1950-, et al.
(författare)
Integrated Care : Pathfindings from Sweden
2013
Ingår i: Integrated care for Ireland in an international context. - Cork, Ireland : Oak Tree Press. - 9781781190807 - 1781190801 - 9781781191040 - 1781191042 ; , s. 90-102
Bokkapitel (övrigt vetenskapligt/konstnärligt)
28.
Åhgren, Bengt, 1950-
(författare)
Integration, not fragmentation
2012
Ingår i: Public service review. Health and social care. - 2045-2357. ; :31, s. 75-76
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
29.
Åhgren, Bengt, et al.
(författare)
Is choice of care compatible with integrated health care? : an exploratory study in Sweden
2012
Ingår i: International Journal of Health Planning and Management. - 0749-6753 .- 1099-1751. ; 27:3, s. e162-e172
Tidskriftsartikel (refereegranskat) abstract
Competitive and integrative policy actions are simultaneously being promoted in Swedish primary care; citizens' choice of care is launched while primary care is expected to integrate its activities with other providers for the creation of ‘local health care’. Competition tends, however, to fragment the provision of services. The aim of this study is, accordingly, to explore whether or not these policies are compatible in practice. For this purpose, strategically designed group interviews were conducted with citizens. When citizens make active choices, they are under the influence of self-perceived conditions: that is, the accessibility of the care, its continuity and the treatment offered by the care provider, conditions which, in turn, have a lot in common with the guiding principles of local health care. On the other hand, citizens who choose passively, because of not being in contact with primary care, have no difficulties in being disloyal to the chosen unit when becoming patients. In doing so, they also contribute to the fragmentation of local health care. Making entirely free choices when it comes to primary care seems to be incompatible with local health care. However, choice of care only partly equals the conditions of free choice. Choice of care and local health care would thus seem to be compatible, in practice, for the majority of patients.
30.
