The ‘politics’ of a changing institutional ecology: coordination, prioritization and labour in Norwegian health, care and welfare services

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. 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. 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 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. Preliminary findings from policy analyses show that logics in welfare policy tend to forefront the content of the services and the directedness and involvement of users, and to a lesser degree focus on the work-intensity required to produce the services and the workforce needed despite the emerging (local) political focus on labour in the services, the problematic part-time structure and the concern for future recruitment of workers. Such a policy framing might contribute to promote the importance of quality in the services as well as user participation, while at the same time silence the conditions for labour and inclusion in labour. Furthermore, 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. Preliminary findings suggest that users of home-help services experience good treatment but poor care, and that their experiences of receiving services are tainted by the many healthcare professionals delivering the services. This may be indicative of a weak relational continuity in the services 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. Another ongoing empirical investigation focuses on how patients with severe and long-term mental illnesses and their next of kin experience receiving services in the home, and the next of kin role as collaborative partner with the services. The concept of ‘pathway’ is another policy tool which pinpoints seamless services where delivery should move along a ready-made trail with planned nodes. Yet, in relation to complex cases the roles and relations of the next of kin need to be problematized regarding such an idea of service delivery. Preliminary findings show that space, place and time are important dimensions in the next of kin situation and in their narrations of their experiences as informal carers. Next of kin may experience ruptures in continuity due to changes in the patients needs, short interventions for long term needs and organisational issues which leads to lack of communication or postponing of treatment. Ongoing empirical studies of new ‘trust models’ in the municipal home-care services show that demands for societal recognition for care work and care competence regularly have surfaced and today emerge through a renewed focus on trust. Furthermore, in the variety of models for service allocation the question concerning fair distribution dominates the discussions and dilemmas. This is illustrative of the municipal services as practitioners of justice, micro-politics and universalism through their work in care.

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.

Publications from Cristin

Revisiting the Nordic long-term care model for older people—still equal?

Reconceptualizing States and Welfare in the North of Europe and Beyond

Who’s in the House? Staffing in Long-Term Care Homes Before and During COVID-19 Pandemic

Absorbing care through precarious labour: the shifting boundaries of politics in Norwegian healthcare

Innovation in persons. An analysis of two prominent academic narratives.

1

NRK Radio intervju: Sjukeheimplassar som forsvinn

NRK nyhetsmorgen: Teknologi som løsning på bemanningskrise i eldreomsorgen?

Ending the revolving door of emergency department visits for older adults.

1

Kvinnehelse, kjønn og arbeid

Analysing the welfare state through the lens of institutional ethnography: the value of everyday experience

The concept of co-production in different academic fields: potentials for critical analysis AND muddle

The re-politicization of primary care through the optic of 'prioritization' and 'crisis' in Norway

Moglegheiter og hindringar i samband med datainnsamling

Kva vilkår har rettferd i velferdsstaten når sosiale spørsmål smeltar?

Understanding emerging models of care and aging in place: A Cross-cultural comparison between Norway and the United States.

1238

Correction to: Revisiting the Nordic long-term care model for older people-still equal? (European Journal of Ageing, (2022), 19, 2, (201-210), 10.1007/s10433-022-00703-4)

Lederes erfaringer med individuell plan i kommunal hjemmetjeneste. En kvalitativ intervjustudie

Erfaringer med COVID-19 i norske sykehjem

Kampar i eldreomsorg

1

Kvinnedagen 8 mars 2022. Arbeid, kjønn og ulikskap

1