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Path Dependence on New Roads. Institutional Development of Quality Registers
Linköping University, Department of Management and Engineering, Political Science. Linköping University, Faculty of Arts and Sciences.ORCID iD: 0000-0001-6803-7414
Linköping University, Department of Management and Engineering, Political Science. Linköping University, Faculty of Arts and Sciences.
2014 (English)In: Offentlig Förvaltning. Scandinavian Journal of Public Administration, ISSN 2000-8058, E-ISSN 2001-3310, Vol. 18, no 2, 3-22 p.Article in journal (Refereed) Published
Abstract [en]

When explaining social development and changes in public administration, institutional changeis a typical focus. Institutional analysis can combine the analyses of changes on the basis offormal legal and informal arrangements; it commonly shows that institutions lead to inertiawhere changes over time are concerned. Political aims are a guide to how organizations aredesigned and governed. When goals and earlier decisions clearly guide change, path dependenceis a fundamental concept when explaining change. However, this analysis shows how andwhen quality registers appeared as an answer to changes in institutional arrangements in Swedishpublic healthcare. Through three phases, cumulative processes have been visible and theprocesses have been followed by an improved and increased usage of quality registers andother quality systems. This analysis shows that institutional development can be pathdependentin relation to methods and means. Despite changing goals over time, quality registersas a policy tool have been path-dependent and stayed firm. Thus, it is important to see alsoorganisational methods as a development path that can be used to implement even new policyaims.

Place, publisher, year, edition, pages
Förlag Göteborgs Universitet, 2014. Vol. 18, no 2, 3-22 p.
Keyword [en]
Institutional change, quality registers, public governance, path dependence, time
National Category
Public Administration Studies
URN: urn:nbn:se:liu:diva-114514OAI: diva2:790656
Available from: 2015-02-25 Created: 2015-02-25 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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Örnerheim, MattiasWihlborg, Elin
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