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Explaining Quality Management in the Danish and Swedish Public Health Sectors: Unintended Learning and Deliberate Co-Optation
Linköping University, Department of Management and Engineering, Political Science. Linköping University, Faculty of Arts and Sciences.ORCID iD: 0000-0001-6803-7414
Department of Society and Globalisation, Roskilde University,Roskilde, Denmark.
2016 (English)In: International Journal of Public Administration, ISSN 1532-4265Article in journal (Refereed) Epub ahead of print
Abstract [en]

This article examines the development of diverse quality systems in the otherwise quite similar Danish and Swedish public health sectors. After decades of numerous piecemeal medical and managerial quality development programs in both countries, a nationwide mandatory accreditation system was introduced in the Danish health services in 2009. Nationwide quality indicator projects are also found in Sweden, but there has been political attempt to introduce a compulsory system. This article seeks to explain this difference. It argues, first, that resistance from the medical professions blocked the introduction of compulsory, nationwide quality systems in both countries for decades. Second, the implementation of the Danish accreditation system was triggered by a combination of unintended policy learning produced by local reforms in two counties and of the Ministry of Health’s carefully orchestrated policy process that served to co-opt critical voices in the medical profession.

Place, publisher, year, edition, pages
Routledge, 2016.
Keyword [en]
Historical institutionalism; path dependency; policy learning; quality managment systems
National Category
Public Administration Studies
URN: urn:nbn:se:liu:diva-128223DOI: 10.1080/01900692.2015.1064959OAI: diva2:930237
Available from: 2016-05-23 Created: 2016-05-23 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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