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Regional Strategies for Sustainable Healthcare The Winding Ways from UN SDGs into Swedish Regional Healthcare Systems
Linköping University, Department of Management and Engineering, Political Science. Linköping University, Faculty of Arts and Sciences.ORCID iD: 0000-0002-9905-0942
Linnéuniversitet.ORCID iD: 0000-0001-6803-7414
Linköping University, Department of Management and Engineering, Political Science. Linköping University, Faculty of Arts and Sciences.ORCID iD: 0000-0002-4680-1124
2022 (English)In: International Journal of Public Policy, ISSN 1740-0600, E-ISSN 1740-0619, Vol. 16, no 2-4, p. 187-203Article in journal (Refereed) Published
Abstract [en]

Sustainable development has been defined by 17 UN goals, with the third goal (SDG3) focusing on a universal healthcare system that ensures healthy lives and wellbeing. To implement these ambitions, the goal needs to fit a regional setting before it can achieve and support healthy lives and wellbeing amongst the population. This article analyses how four Swedish regions incorporate SDG target 3.4 on non-communicable diseases and mental health into their respective healthcare organisations. The comparative analysis applies the lens of normative institutional theory to policy documents and interviews. All the regions recognise SDG3.4 by acknowledging the need for health promotion. The results show a general absence of similarities in organisational practices and policy outcomes, which is explained by region-specific factors and a lack of governmental coordination. The analysis shows that local policy core values and the related logic of appropriateness predict local outcomes of implementation of general global policies.

Place, publisher, year, edition, pages
InderScience Publishers, 2022. Vol. 16, no 2-4, p. 187-203
Keywords [en]
Normative Institutionalism; UN Sustainable Development Goals; SDG; Regional Healthcare; Localization; Sustainable health care; Local Government.
National Category
Political Science
Identifiers
URN: urn:nbn:se:liu:diva-186691DOI: 10.1504/IJPP.2022.124780OAI: oai:DiVA.org:liu-186691DiVA, id: diva2:1679016
Available from: 2022-06-30 Created: 2022-06-30 Last updated: 2023-11-17
In thesis
1. Inramningar av lömska problem: Fallstudier av lokala förvaltningars möte med hållbarhet i sjukvård och under pandemin
Open this publication in new window or tab >>Inramningar av lömska problem: Fallstudier av lokala förvaltningars möte med hållbarhet i sjukvård och under pandemin
2023 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[en]
Framing Wicked Problems : Case studies on sustainability in healthcare and during the pandemic
Abstract [en]

Everything should come together, and everything should permeate everything. Trends in governance and policy areas have come to encompass increasingly broader and more diverse issues. For example, sustainable development should guide all parts of government, but there is often little guidance on what this means in practice and how organizations should tackle the diverse issues and challenges of sustainability. Overall, much indicates that the challenges and problems faced by decision-makers in public administration have become increasingly difficult to manage. Some of these problems are particularly challenging and cannot be solved with a short term solution, by a single actor, or by an established method. These problems can only be managed and are referred to as "wicked problems" in the literature.

The dissertation focuses on two wicked problems: sustainability and a pandemic. The analysis address how these wicked problems are handled by local public authorities in Sweden. Both problems have an unclear scope, a vague definition, and no definitive solution within reach. The overshadowing argument is that wicked problems need to be framed to be managed through policy mechanisms and implementation processes. The thesis argues that a frame determines and delimits the issue at hand, thus configuring what becomes manageable or not in practice.

The dissertation is based on a selection of empirical case studies aimed at observing how governments translate the problems they face by handling both the need to become more sustainable and balancing the needs during a pandemic through changes and modifying the discourse. The study employs an interpretive and constructivist analysis of document studies and interviews with key stakeholders.

The overarching conclusions indicate that framing is a central process necessary to move wicked problems forward on the political agenda and make them manageable. In this way, framing helps to delimit the problems; the framing becomes crucial for what becomes manageable and what is left out. Frames have different characteristics, which then influence how the problem is addressed. The conclusions suggest a continued need to make the wickedness of policy problems visible, to consider the larger and more complex aspects of certain political issues, and to strive to identify different mechanisms for managing them. We can see that framing is not just about coping with wicked issues but also about redefining the understanding of wicked problems to align more closely with an organization's limitations and possibilities. Framing offers the possibility to bridge, merge, or even transform our understanding of the wicked problem through the social reality of the organization.

Abstract [sv]

Allt ska gå ihop, och allt måste genomsyra allt. Styrtrender och politikområden har kommit att omfatta allt mer och allt bredare frågeställningar. Sammantaget pekar mycket på att de problem som beslutsfattare och verksamheter ställs inför har blivit svårare att hantera. Några av dessa problem är särskilt svåra för offentligheten, och de kan inte lösas på traditionella sätt. Dessa problem kan endast hanteras och kallas i litteraturen för lömska problem. Avhandlingen tar sig an hållbarhet som ett sådant lömskt problem, med fokus på hälso- och sjukvård samt COVID-19-pandemin. Båda fallen har en oklar omfattning, en vag innebörd och det finns heller inget definitivt slut som är nåbart inom en snar framtid. Det övergripande argumentet är att lömska problemen behöver ramas in för att kunna hanteras av organisationer. Ramen avgör och avgränsar sakfrågan, och vad som blir hanterbart eller inte.

Analyserna utgår från och bygger på ett urval av empiriska studier om hållbar hälsa samt COVID-19-pandemin. Forskningsdesignen för att studera hanteringen av dessa två lömska problem bygger på en tolkande och konstruktivistisk analys av dokument och intervjuer med nyckelaktörer.

De övergripande slutsatserna pekar på att inramning är en central process som gör lömska problem hanterbara. Genom inramning avgränsas problemen; inramningen blir avgörande för vad som blir hanterbart och vad som lämnas utanför. Resultaten visar att organisationer använder olika strategier för att rama in lömska problem. Strategierna bygger på befintliga institutioner och organisatoriska handlingsmönster, med följd att det ursprungliga lömska problemet antingen förbinds, förenas och/eller förändras. Slutsatserna understryker behovet av att fortsätta synliggöra lömska problem inom olika policyområden, att uppmärksamma de större och mer komplexa aspekterna av vissa politiska frågeställningar, samt att fortsätta identifiera olika hanteringsmekanismer.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2023. p. 89
Series
Linköping Studies in Arts and Sciences, ISSN 0282-9800 ; 866
Keywords
Wicked Problems, Framing, Governance, Local Government, Sweden, Lömska problem, Kommunal styrning, Styrning, Inramning
National Category
Public Administration Studies
Identifiers
urn:nbn:se:liu:diva-199197 (URN)10.3384/9789180754279 (DOI)9789180754262 (ISBN)9789180754279 (ISBN)
Public defence
2023-12-15, ACAS, A-huset, Campus Valla, Linköping, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2023-11-17 Created: 2023-11-17 Last updated: 2025-02-21Bibliographically approved

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Wihlborg, ElinSommar, Carl-Johan

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