This strategic project to build institutional expertise aims to develop the field of services research through a multidisciplinary and comparative exploration of the ways services interaction and coordination are politicized, prioritized, organized, practiced and experienced at different levels and by different actors in the Norwegian welfare state. We focus on how social and structural dynamics shape conditions for municipal welfare services, and identify factors that may promote or hinder priorities related to service collaboration.
The municipal healthcare sector is one of several sectors which forms the institutional landscape of the Norwegian welfare state. Primary healthcare is decentralized and the municipal healthcare services constitute the institutional backbone of the welfare state. The municipal healthcare services are our point of departure. Our project relates to the contemporary societal challenge of welfare regime capacity, and how to build sustainable public services based in the principle of universalism which forefronts equal access to services of equal quality.
Our research focus in four work packages covers a wide range of dynamics which will provide new knowledge about services interaction, collaboration and prioritization and includes an exploration of; conditions for developing sustainable services; labour that produces healthcare services; organization and governance of the municipal services; policies and practices of services coordination; national and international policy trends in healthcare and welfare. The project is managed by the Centre for Care Research west (CCRW), Western Norway University of Applied Sciences (HVL), and include five national partners - CCR East, South, Mid, North and NORCE Society, and four international partners UCSF, MSU, NIVEL and Aarhus University.
Findings from policy analyses show that logics in welfare policy tend to forefront the content and quality of the services and the directedness to and involvement of users, and that they to a lesser degree are focused on the work-intensity and workforce in service production and the relational characteristics of care work. This is despite the emerging public focus on labour and labor conditions in the services and the problematic part-time structure, although the recruitment issue recently has got attention. Such an individualized policy framing might contribute to promote the importance of user participation, service quality and coordination, while at the same time contribute to silence structural conditions for labour and the gendered dimension of care work tying it close to the pole of social reproduction in modern welfare states. In a document analysis on the emergence of new ‘trust models’ in the home care services, we find that calls for recognition of care work and of care workers competencies occurs throughout history.
In an ongoing meta synthesis of Scandinavian research, and in an empirical case study, continuity in the services is explored through users experiences of flow and stability while receiving services. Continuity is understood both as a policy tool which carries the ideal of services coordination, yet also as a concept widely used in a variety of ways in research. Analytically it is therefore useful to specify three forms of continuity – relational, informational and systemic – which are explored in the context of users experiences. Findings shows that users of home-help services experience good treatment but poor care, and that their experiences of receiving services are tainted by the high number of healthcare professionals delivering them services. This indicates that the relational continuity is weaker than the informational and systemic in the services, something which may be caused by extensive use of part-time work, high labour intensity and deprioritizing of tasks deemed less important in a work situation characterized by time pressure. Ethnographic case studies, and a systematic review, of models and principles for service allocation both confirms and expand findings from the meta synthesis. Preliminary findings here show that allocation of long-term care services (LTC) turn toward prioritizing potentiality, reablement and medical needs, and that in re-interpretations of needs a tendency of rising thresholds and de-prioritization of social and relational needs occurs. In different models of allocation of services we find that a commonality is the interpretation and problematization of just distribution and universalism. This illustrates that the municipal services perform the welfare stately ideals, and that the municipal employees, or street-level bureaucrats, conduct micro-politics through everyday work. In an empirical case study patients with long term mental illness and their next of kin's experiences with coordinated 'care pathways' is explored. Findings show that next of kin experience breaks in contiuity due to short interventions planned for long-term needs.
This strategic project to build institutional expertise aims to develop the field of services research through a multidisciplinary and comparative exploration of the ways services interaction and coordination are politicized, prioritized, modelled and experienced at different levels and by different actors in the Norwegian welfare state. We will identify social and structural factors that may contribute to reduce unwarranted variations and priorities related to services coordination, and potentially contribute to ensure sustainable services. The project is situated within a contemporary paradox faced by every European state. On the one hand, there is a need for cutting public expenditure because of lower state remuneration and of austerity, an effort given force through current NPM policies. On the other hand, there is a greater demand for public services caused by societal changes spurred by changes in the market, such as the global decline in employment, increased migration flows and increased complex health care issues in the population. This projects ambition is to build a theoretical informed and potent policy influential services research through a practice-based methodological and critical multi-scalar scope on the challenge fragmented services provision represents for a sustainable welfare regime. We explicitly aim at developing services research by the use of a range of theoretical prisms, whereby the overall prism opens for an understanding of public services as co-related within a particular Norwegian ‘institutional ecology’. Understanding public services as a key to the welfare states’ egalitarian ideology, we also explore the role of municipals as agents counteracting inequality.
The project is managed by the Center for Care Research (CCR) west, Western Norway University of Applied Sciences (HVL), and includes five national partners - CCR East, South, Mid, North and NORCE Society, and four international partners UCSF, MSU, NIVEL and Aarhus University.