Abstract The Danish healthcare system is often criticised for the lack of collaboration across sectorial boarders. The lack of co-ordination in the continuity of care primarily affects patients groups who have the greatest need for stability and consistency. These patients are the elderly medicine patients, older than 65 years, often with multi chronic illness and in need of daily care and long term treatment. The fact that the collaboration between general practice, the hospital and primary care often is known as a ‘greyzone’ or ‘cleavages’ specifies the problem. A clinical pathway and shared care system is often voiced the solution. Because of the way healthcare is organized, weak links exist throughout the chain of communication. Central to this main thesis is the idea that the Danish healthcare system is in need of change and a shift in sets of values if it is to meet the demands to fill out `the good clinical pathway´. These changes are needed in the organizational interpretive scheme and in the design of the structures dominating the health care at field level. Therefore, the main purpose of this master thesis is to elaborate and shed light on the barriers and opportunities for a movement towards collaboration in the system and between the professionals that work with planning (consultant and government offices) and those who practice, i.e the front line workers, doctors and nurses. The research takes place as a single embedded case study focusing on the cross-sectorial collaboration between intra level in the Danish County Hillerød Kommune, Hillerød Hospital and the doctors in the GP offices/primary care. These were chosen due to the theoretical suggestion that it is often the members of an organisational field that act as agent for new ideas and changes in practice. Theoretically, the inquiry has been based on new institutional theories focusing on relational co-ordination and frontline employees in the welfare state. Institutional theory has been used to define the healthcare institutions field and to describe the implications for change toward co-ordination. The term ‘relational co-ordination’ suggests the solution is through shared goals, shared knowledge and mutual respect; which has been supported through data collected from eleven semi-structured interviews. There are still a great number of myths and compartmentalisation within the field and a lot needs to be done to rectify this. The study shows that despite many years introducing new programmes to create a solution to these problems, these have not been able to change the traditional organizational design – a design that does not fit the needs of complicated patient with special needs, however, it can be said that a number of new values have been discovered. In the light of this, a central conclusion is that the underlying values and the organisational design must undergo concurrent dramatic change in both the field level structure and in the sets of values and norms.
|Uddannelser||Offentlig Administration, (Bachelor/kandidatuddannelse) Kandidat|
|Udgivelsesdato||30 aug. 2012|