Den här rapporten belyser och analyserar svårigheterna att implementera lagstiftning som tillkommit under senare år för att ge patienter bättre möjligheter att påverka den vård de får. I patientmaktsutredningens delbetänkande om Patientlag (SOU 2013:2) uppmärksammas eftersläpning i implementeringen av flera av de åtgärder som trädde i kraft år 2010 som vårdgaranti, fast vårdkontakt och förnyad medicinsk bedömning (prop. 2009 /10:67 Stärkt ställning för patienten). De mest framträdande lagändringar som skett under senare år för att stärka patienters ställning är rätten till vårdval, det vill säga att välja vårdgivare inom och utom regionen (SFS 1982:763), rätten att få en förnyad medicinsk bedömning en så kallad second opinion (3 a § SFS 1982:763), rätten att få vård inom viss tid, den så kallade vårdgarantin (SFS 1982:763), samt möjligheten att välja vårdgivare inom EU. Sammantaget handlar det om åtgärder som ska stärka patientens ställning och ge den enskilde patienten inflytande över hälso- och sjukvården (SOU 2013:44).

Frågor om patienters inflytande i vården är inte nya. De har successivt vuxit fram. Ett viktigt steg togs redan år 1990 då patienter i de flesta landsting fick möjlighet att välja vård utanför det egna landstinget. Det dåvarande Landstingsförbundet rekommenderade då landstingen att utöka patientens valmöjligheter av utförare över landstingsgränserna (SOU 2013:2). Sedan dess har policyer för att stärka patienters inflytande, engagemang och delaktighet i sin egen vård och hälsa uppmärksammats i flera utredningar och lagförslag.

Denna rapport analyserar implementeringen av patientlagstiftning. Syftet är dels att utifrån fallstudier belysa hur lagstiftning om vårdens skyldigheter i förhållande till patienter implementeras och dels att analysera hur och varför utfallet varierar, för att kunna diskutera möjliga sätt att förstärka implementeringen av denna lagstiftning. Syftet konkretiseras i dessa övergripande forskningsfrågor:

1. Hur påverkas implementeringen av patientlagstiftning av det regionskommunala självstyret?
2. Hur påverkas implementeringen av patientlagstiftning av lagstiftningens utformning?
3. Hur bidrar eller hindrar sjukvårdens professioner implementeringen av lagstiftningsåtgärder som syftar till att stärka patienters inflytande i vården?
4. Hur bidrar eller hindrar medborgarna implementeringen av lagstiftningsåtgärder som syftar till att stärka patienters inflytande i vården?....

The road transport system is moving, slowly but surely, away from using fossil fuels. Plug-in electric vehicles (PEVs) are an energy-efficient alternative to conventional vehicles. Commercial vehicle fleets are an attractive entry for PEVa into the transport system. This paper presents findings from a three-year study of 550 PEVs and their users. A combination of technical and social science methods provides a basis for greater understanding of PEV operations in commercial vehicle fleets. This paper shows that battery electric vehicles (BEVs) have proven their functionality in several applications, but that winter conditions still imply an unjustified decrease in use. Usage varies according to application but results show that in general a substantial share of the battery capacity is redundant. Findings indicate that usage is not necessarily inhibited by the technical specifications of the battery but by the operational conditions in which commercial duties are performed. The only reliable alternative is to return with a large battery surplus. The vehicles studied have demonstrated their functionality and the users are positive. Plug-in hybrid electric vehicles (PHEV) imply no restrictions in mobility, which results in high user satisfaction. Commercial vehicle fleets are suitable for PEV operations and with growing acceptance users have requested more PEVs hence a significant possibility exists to substitute a large share of the fossil-fuelled vehicles operating in commercial vehicle fleets. (C) 2015 The Authors. Published by Elsevier Ltd.

This paper focuses on the construction of citizenship online, through an analysis of independent blogs as well as member blogs of NGOs, all being written by young Swedish cancer patients. The findings show that citizenship is co-constructed in complex interplays. Blogging and support from NGOs open up new forms of everyday practice, extending the concept of citizenship. The importance of NGOs being online is highlighted in this context. The NGOs are supporting their members’ efforts to become more active citizens as well as providing tools for non-members to become more active as patients. Individual blogs are also important, as they can be seen as self-organised networks providing an interactive link among the writer, the commentators, and the readers in the construction of citizenship.

Purpose – The purpose of this paper is to illustrate how accountability is expressed in contractual arrangements found in network governance structures that provide public transport services and to raise discussion of how to understand contracting accountability in network governance contexts.

Design/methodology/approach – The paper is rooted in two research traditions: contracting studies and studies of accountability in government/governance contexts. Content analysis is used in examining contracts from two cases. These contracts are of five types: contracts between public organizations, contracts within a public organization, contracts between public organizations and private firms, and contracts between political parties within a municipality and contracts within a network. Various contracting approaches are identified within these types.

Findings – The paper concludes that the contracts' functions differ between the cases. The first case did not have an overall contract that defined the network, relying on different two-party contracts instead. In the other case, an incentive-based contract was used to link the organizations. From an accountability perspective, the latter contracting structure clarifies the roles and responsibilities of the actors and increases the possibility of accountability to citizens.

Originality/value – The paper brings new insights to the field of contracting and accountability by focusing on the role of contracts in network governance structures, taking account of various accountability relationships. It also contributes new theoretical categories usable when analysing contracting accountability in a network context

Commercial vehicle fleets are in many ways an attractive entry for electric vehicles into the transport system. In total, 174 electric vehicles have operated in commercial vehicle fleets and gathered socio-technical data over a period of 18 months, resulting in 302,000 all electric kilometres. This paper presents two perspectives regarding electric vehicle operations in commercial vehicle fleets - the functionality perspective, illustrated by the vehicle actions, and the user perspective that addresses the implementation of the task. The socio-technical analysis has resulted in four major findings. With time, the overall usage and the driving distance between charging occasions increase. It is not the passage of time that has influenced this behaviour but it may be explained as the result of accumulated experience. Swedish winter conditions show regression in usage, foremost due to users not familiar with the range reduction caused by the heating system. The need for public charging has been shown to be modest, which in an introductory phase with limited development of charging infrastructure, makes commercial vehicle fleets favourable to electrify over private vehicle fleets. According to deployment strategy, the different user groups ability to incorporate the electric vehicles in their daily activities has been explored and this paper shows large potential for substituting traditional internal combustion engine vehicles within commercial vehicle fleets. Electric vehicles have been made available through a technology procurement scheme and have generated both kilometres and experience, which has come to increase the understanding of the usage of electric vehicles in commercial vehicle fleets.

This paper concerns steering aspects in the governance context of public transport. Various theoretical views of steering have been presented over the years, and it has been argued that a multiple-principal context often leads to fragmented steering. The paper aims to identify steering culture models found among principals operating in the same public transport context, and to explain how a successful procurement outcome is possible, despite the hybrid of steering cultures. The paper is based on an empirical analysis of a Swedish county's planning process that resulted in a very successful procurement outcome that met high environmental and safety standards at a relatively low cost. This procurement was seen as a triumph by principals. The findings presents the existence of various steering cultures among the principals, leading to the conclusion that a “metagovernor,” in this case the PTA, is central to achieving successful outcomes. The metagovernor designed the planning process and formulated a procurement document that satisfied the principals. In this process, the metagovernor negotiated separately with each principal, focusing on the particular characteristics of each principal.