Deeply Rooted Traditions and the Will to Change-Problematic Conflicts in Three Swedish Health Care Organizations

By Brorstrom, Bjorn; Siverbo, Sven | Journal of Economic Issues, December 2004 | Go to article overview
Save to active project

Deeply Rooted Traditions and the Will to Change-Problematic Conflicts in Three Swedish Health Care Organizations


Brorstrom, Bjorn, Siverbo, Sven, Journal of Economic Issues


The Need for Change in Swedish Health Care Organizations

The health care sector in Sweden has had two major problems to deal with during the last decade. The first is long waiting lists at hospitals, and the second is recurrent deficits in operating statements. On one hand there is a need for increased treatment and more surgeries, and on the other it is increasingly difficult to finance the operations. For some of the health care entities, the financial development has resulted in an equity ratio close to zero and a rather weak financial position.

In Sweden the county councils are responsible for the major part of the health care services. The regions and the councils can be regarded as large health care organizations governed by directly elected politicians. The constitution states that these organizations are autonomous; thereby the politicians (and managers) have the opportunity to make, and responsibility for making, necessary changes. But the regions and councils are not independent of the State. The government controls some of their financial resources and the National Board of Health and Welfare some of their operations.

If change is not initiated and implemented by the actors in the organizations' subunits, the responsible politicians and managers have to engineer it. Political decisions about priorities and cutbacks seem to be necessary, but for this to happen two conditions must be fulfilled. The first is that politicians and top managers that are responsible for producing the foundations for the decisions are aware of the problem. Lack of awareness can of course cause an unwanted status quo. The second is that they must have the strength to implement measures. It is not hard to imagine that there can be resistance against top-level decisions in health care organizations. Politicians and managers must be able to control the implementation process. This reasoning means that there are three situations where necessary measures will not be taken:

1. When politicians and managers lack awareness of the problem-in spite of implementation strength.

2. When politicians and managers lack the strength to implement measures-in spite of awareness of the problem.

3. When politicians and managers lack both awareness and strength.

Our overall research question is, Which are the constraints to implementing change? Our contribution to an already well-investigated question is a consequence of the way we illuminate the described phenomenon and our theoretical perspective.

Purpose, Case, and Method

The purpose of this article is to explain why necessary change has not occurred in Swedish health care organizations. The analysis is based on an institutional perspective and is limited to intra-organizational impediments to change. More specifically we are investigating whether the lack of change can be explained by lack of awareness of the problem, lack of strength to engineer change, or both in the executive health care organization management.

In order to answer the question, three case studies have been carried out. Case studies are appropriate when a phenomenon needs to be investigated in depth, and our judgment is that there was need for deep understanding of the development in a few health care organizations rather than shallow understanding of several.

For our case studies we wanted three health care organizations that fitted well in the general description of the problems in the health care organization sector. We found that Dalarna, Gavleborg, and Vastmanland matched this criterion. They had all faced a period of more than ten years of financial stress and long waiting lists for surgeries and treatments. There was (and had been for some time) need for change, but change had not occurred. The three counties are geographically located in the middle of Sweden and have approximately a quarter of a million inhabitants each.

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Deeply Rooted Traditions and the Will to Change-Problematic Conflicts in Three Swedish Health Care Organizations
Settings

Settings

Typeface
Text size Smaller Larger
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

While we understand printed pages are helpful to our users, this limitation is necessary to help protect our publishers' copyrighted material and prevent its unlawful distribution. We are sorry for any inconvenience.
Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.