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Policymaking through healthcare registries in Sweden
Linköping University, Department of Management and Engineering, Political Science. Linköping University, Faculty of Arts and Sciences.ORCID iD: 0000-0001-6803-7414
2016 (English)In: Health Promotion International, ISSN 0957-4824, E-ISSN 1460-2245Article in journal (Refereed) Epub ahead of print
Abstract [en]

Healthcare registries, otherwise known in Sweden as national quality registries (NQRs), have progressed from being a patient-focused system supporting medical results to become the basis of a health policy steering instrument called regional comparisons (RCs). This article seeks to explain RCs as an unintended consequence of the NQR development, by utilizing the concepts of policy entrepreneurs and streams of impact: the problem stream (problem perceived), the policy stream (what is valid), and the political stream (governmental objectives). The empirical contribution lies in insights on how the RCs have developed as an unintended consequence of entrepreneurial deliberate action in the process of creating NQRs. These findings are based on documents, interviews, and previous research in the social sciences. The article also argues for a critical understanding of public knowledge management (PKM) related to experiences in the development of NQRs regarding how to use knowledge in healthcare government. This article highlights how knowledge generated in quality systems based on registries could imply a stronger role for authorities in exerting control over the medical profession. It also discusses the potential use of research evidence on NQRs as a base for more efficient policymaking.

Place, publisher, year, edition, pages
2016.
Keyword [en]
quality registries, stream coupling, policy entrepreneurs, public knowledge management
National Category
Political Science
Identifiers
URN: urn:nbn:se:liu:diva-131037DOI: 10.1093/heapro/daw064PubMedID: 27594141OAI: oai:DiVA.org:liu-131037DiVA: diva2:958174
Available from: 2016-09-06 Created: 2016-09-06 Last updated: 2016-09-12Bibliographically 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.
Series
Linköping Studies in Arts and Science, ISSN 0282-9800 ; 690
Keyword
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
Identifiers
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)
Opponent
Supervisors
Available from: 2016-08-31 Created: 2016-08-31 Last updated: 2016-09-06Bibliographically approved

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