Stefan Szücs and Inger Kjellberg
The purpose is to analyse the relationship between democratic accountability and how sustainable governance is achieved by horizontally integrating care services for older people…
Abstract
Purpose
The purpose is to analyse the relationship between democratic accountability and how sustainable governance is achieved by horizontally integrating care services for older people through collaboration in a coordination body of key leaders from across the health and social care system.
Design/methodology/approach
The data and measures come from two surveys with coordination body members in Sweden (politicians, administrators, professionals) from a sample of 73 bodies in 2015 (n = 549) and the same/corresponding 59 bodies in 2019 (n = 389).
Findings
The governance of integrating care scale and the accountability scales repeatedly show consistency among individual members. Systematic progress is found among large coordination bodies: the greater the average perception of governance of horizontally integrating care in 2015, the greater it was in 2019 – and regardless of the period, the stronger the internal administrative or political monitoring and reviewing of the coordination body, the greater its governance (while the relationship to the external monitoring and reviewing is weak). However, the growing importance of external accountability is indirect, shown by stronger correlations between the internal political and external monitoring and reviewing, regardless of size.
Research limitations/implications
The scales are based on self-reported perceptions that cannot be objectively verified, but they can be linked to changes in outcomes and user experiences in the later stages of the research.
Originality/value
Repeatedly verified scales of internal and external accountability for analysing and evaluating governance of integrating care services horizontally, which is useful for improving strategic coordination of integrated care.
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Inger Kjellberg and Stefan Szücs
The purpose of this paper is to explore stakeholder views on the policy of integrated health and social care for older people with complex needs in Sweden and the issue of trust…
Abstract
Purpose
The purpose of this paper is to explore stakeholder views on the policy of integrated health and social care for older people with complex needs in Sweden and the issue of trust in implementing the policy.
Design/methodology/approach
The study used a qualitative interview design and interviews with nine strategically selected stakeholders. A thematic analysis focused on trust, as defined in the theory of collaborative advantage, was used.
Findings
This study of health and social care exposed a lack of trust on political, strategic and inter-professional levels. Two opposing lines of argument were identified in the interviews. One advocated a single government authority for health and social care. The other was in accordance with recently implemented national policies, which entailed more collaboration between local government authorities, obliging them to make joint local agreements. The Swedish experience is discussed in an international context, examining the need for collaboration in integrated care services for older people.
Research limitations/implications
Although the findings are important for the current adjustment in health and social care for older people, the number of interviewees are limited. Future studies will include more regions and longitudinal studies.
Originality/value
Sweden is currently undergoing an extensive adjustment in line with recent national government policy which involves more primary health care and a corresponding reduction in the number of hospital beds. The restructuring of the care system for older people with complex needs is a paradox, as it simultaneously increases the need for centralisation while also increasing coordination and collaboration on a local basis.
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Lisa Björk, Stefan Szücs and Annika Härenstam
This study aims at developing a measure that can be used to evaluate organizational capacity to perform across local government jurisdictions, using operational managers' own…
Abstract
Purpose
This study aims at developing a measure that can be used to evaluate organizational capacity to perform across local government jurisdictions, using operational managers' own assessments.
Design/methodology/approach
The “management matters” literature that links organizational capacity to service performance is far from reaching any consensus on how to operationalize organizational capacity. In this study, over 400 operational managers were asked, at two different time points and in thirty different local government departments, about what opportunities they have to fulfill their responsibilities and about their perceptions of service performance. The data are factor analyzed, and the proportion of higher level variance of the resulting capacity measure is explored.
Findings
Organizational capacity to perform represents a consistent measure that covers essential aspects of the managerial assignment and is empirically distinct, yet positively related to the managers' perceptions of service performance. Results further show that up to 12 percent of the variance in organizational capacity to perform can be attributed to the organization in which managers work.
Practical implications
A service-neutral measure of organizational capacity to perform should be useful to strategic managers in organizations as guidance for resource allocation, and for the design of solid organizational structures and support systems for operational managers.
Originality/value
Recent public management research indicates that rationalistic management models are often inadequately grounded in the day-to-day practices of operative managerial work. The construct of organizational capacity to perform presented in this study could be a valuable instrument that can bridge this strategic-operational disconnect and provide an insider perspective of the organizational prerequisites that underpin any public service achievement.