The objective of this paper is to describe, increase the understanding of, and contribute to a theoretical development of how to look at care planning in public health care in Sweden. By transferring some of the medical care from hospitals to a patient's actual home in the 1990s, valuable beds at hospitals were made available to other patients. Patients who have been properly medically treated at hospitals should be discharged from the hospital as soon as possible. This enables a transferral of aftercare to the patient's home or to a municipally organised living accommodation for e.g. the elderly. In order to make sure that patients receive continued care after their discharge from the hospital, Sweden introduced a law concerning co-ordinated care planning (SOSFS 2005:27). This law prescribed that professionals at hospitals should work together with the patient, close kin and caretaker representatives (primarily in the patient's municipal) in order to agree on the need for continued care. In practice this means that an assistance administrator (the person who makes decisions concerning municipal care efforts) a nurse from the municipal home health care system, a nurse from the hospital department at which the patient was admitted, alongside with the patient and his or her close kin should form a care planning team who meet in order to plan the continued need for care. Ultimately the doctors have formal responsibility. In addition to this law, there are agreements between the county council responsible for the medical care and municipals responsible for home health care, well prepared routines for practical approaches, as well as IT support making sure that information is properly transferred to safeguard the safety of the patient and smooth processes (Region Skåne 2011). Despite legislations, governing and control, there are a number of problems when it comes to actual co-ordinated care planning, why is that so? (Augustinsson 2010; Judge 2003; Czarniawska and Lindberg 2006; Lidén 2009; Lindström 2011). This was the basis of the research assignment, i.e. studying actual events behind co-ordinated care planning and developing theoretical models that may be of use to the care planning team. Rather than focusing on the research objective, we asked "What happens in the process of co-ordinated care planning?" This question formed the basis of ten semi-structured interviews with nurses working with co-ordinated care planning at a hospital. We focused on events, interpretations, experiences and emotions in order to follow up with questions that could offer more details on descriptions and analyses. At the introductory phase of the analysis of the transcribed interviews, we asked the following questions "What is going on here?" and "What do the natives [professionals] think they are up to?" From these analyses of the empirical material (interviews as well as documents) and previous theoretical viewpoints of researchers and their knowledge of the field, one overall question emerged: "What happens in the gap between formal structure such as legislations, routines and standardised procedures, and the informal meaning actual co-ordinated planning processes?" The empirical material also included observations of mutual meetings at the hospital between nurses working with co-ordinated planning. The empirical material, based on the answers to the questions above, have later been addressed from various theoretical aspects in order to open up and create new perspectives on events and new theoretical models. This approach means that neither empirical material nor theories are taken for granted. The conclusion of the study, albeit preliminary, is that too many routines and regulations in a co-operation will make professionals unable to see solutions found outside of the predetermined boundaries. The detail level of regulations may be such a problem. This has been frequently discussed and is a known phenomenon among researchers studying knowledge development, safety and quality in organisational work (Dreyfus and Dreyfus 2003; Weick 2009).
|Status||Publicerad - 2012|
|Evenemang||Presentation at XVI Annual Conference of the International Research Society for Public Management (IRSPM), Rom - |
Varaktighet: 1980-jan.-01 → …
|Konferens||Presentation at XVI Annual Conference of the International Research Society for Public Management (IRSPM), Rom|
|Period||80-01-01 → …|
- Arbetslivsstudier (50903)