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I skuggan av Ädel - integrering i kommunal vård och omsorg

Doktorsavhandling
Författare Eric Carlström
Datum för examination 2005-11-11
ISBN 91-628-6588-9
Förlag Göteborg University
Förlagsort Göteborg
Publiceringsår 2005
Publicerad vid Förvaltningshögskolan
Språk sv
Ämnesord Ädelreformen, municipality, hom-care, social welfare workers, nurses, management control, integration, differentiation, co-operation
Ämneskategorier Studier av offentlig förvaltning

Sammanfattning

The starting-point of this study is the subject of difficulties in integration. Is it possible to control the integration of occupational groups within an organization? To answer this question the welfare departments of four municipalities were examined. Two occupational groups were chosen by their overlapping tasks, long history and separated growth. These two groups, social welfare workers who peform home-help services, and trained nurses who perform homemedical care, have as an effect of legislation from one day to another been amalgamated in a common organization.

This process too place in 1992 by a reform named "Ädelreformen". That year the municipalities in Sweden were directed to integrate home-help services with homemedical care. Social workers and nurses have, after the reform, in a common organization continued to represent different legislations and occupational traditions during the process of integration that began with "Ädelreformen".

An exposition of studies on integration points out that integration is regarded as something good by legislators and managers but is often characterized by conflicts, especially between two parties with different occupational perspectives and overlapping areas.

This study is focused on understanding management control promoting integration. Three types of control of special importance to this study are: need of resources, right of dispositions, and regulation. Integration is supported by a mutual need of resources between the subordinated parties. Need of resources occur when one party depends on another party for survival and growth. The right of disposition is resources protected by the executives. Such protection supports integration among the parties while the risk of exploiting and asymmetry are reduced. During conflict and differentiation a superior party, the executives, can contribute to stabilization by regulation. Regulation consists of rules from the superior party that state how the interchange of resources should be done between the subordinated parties.

Four municipalities have been examined in order to answer the question of this study. Interviews were carried out in each municipality, with executives and subordinated parties, individually and in groups of staff, totally 28 interviews with 85 respondents in total.

The four municipalities performed different types of management control. Those were neglect control, market control, partiality control and symmetrical control. Neglect control is when the executive lacks insight in the relation of the subordinated parties. The lack of insight contributes to an unregulated relation between the parties and weak rights of dispositions. The parties compete and claim the resources of the opposite party. Market control brings a strong need of resources to the subordinated parties. A purchaser-provider split allows the parties to accomplish resources by negotiations. Partiality control is when the executives support one of two subordinate parties. The weaker party is exploited by the opposite party. Symmetrical control implies secured rights of disposition. When symmetrical control is performed by the executives the mutual interchange between the parties is regulated. That prevents isolating and differentiating strategies.

The result and the main contribution of this study is that management control matters and increases the possibilities of integration. When the executive establish distinct rules, strong rights of dispositions and need or resources, mutual interchange is promoted. Those three components in combination reinforce integration. The mutual interchange then repeated will make the integration grow stronger.

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