Pursuing collaborative advantage in Swedish care for older people: stakeholders' views on trust

Abstract

PurposeThe purpose of this paper is to explore stakeholder views on the policy of integrated health and social care for older people with complex needs in Sweden and the issue of trust in implementing the policy.Design/methodology/approachThe study used a qualitative interview design and interviews with nine strategically selected stakeholders. A thematic analysis focused on trust, as defined in the theory of collaborative advantage, was used.FindingsThis study of health and social care exposed a lack of trust on political, strategic and inter-professional levels. Two opposing lines of argument were identified in the interviews. One advocated a single government authority for health and social care. The other was in accordance with recently implemented national policies, which entailed more collaboration between local government authorities, obliging them to make joint local agreements. The Swedish experience is discussed in an international context, examining the need for collaboration in integrated care services for older people.Research limitations/implicationsAlthough the findings are important for the current adjustment in health and social care for older people, the number of interviewees are limited. Future studies will include more regions and longitudinal studies.Originality/valueSweden is currently undergoing an extensive adjustment in line with recent national government policy which involves more primary health care and a corresponding reduction in the number of hospital beds. The restructuring of the care system for older people with complex needs is a paradox, as it simultaneously increases the need for centralisation while also increasing coordination and collaboration on a local basis.

Exploring mandatory reporting in social care and social services in Sweden

“…To our knowledge, this is the first time an overview of staff-reported incidents in social services has been conducted to provide an analysis of types of incidents, contributory factors and actions. Previous studies from Sweden have focussed on either elderly care (Kjellberg, 2012;Rytterström et al, 2013) or disability services (Björne et al, 2021), and these studies have not analysed as large a sample as this one: all reports from one large region in Sweden over the course of a year.…”

“…Furthermore, clarity in reporting and responding may ensue with the development of statutory guidelines (Donnelly, 2019). In the Swedish context, clarity on what to report and how to respond has been questioned by staff (Kjellberg, 2012) and the HSCI (2016), and the revision of the legislation in 2010 was a step forward to remedy some of the misunderstandings (Kjellberg, 2020). Internationally, the lack of clarity in both reporting procedures and what to report has been raised as an issue in need of amendment (Montgomery et al, 2016).…”

A Multilevel Framework for Complex Care: A Critical Interpretive Synthesis

“…To achieve this aim, care coordinators facilitate communication and collaboration in the development and implementation of complex care plans that involve multiple providers, services, and sectors. Te scope of care coordination initiatives varied: care coordination was used to address transitions in care [41,42], to enhance primary care [28,30], and to span the continuum of care across ongoing, integrated, or intersectoral treatment [43,44].…”

Does the indicator of relative need (IoRN2) tool improve inter-professional conversations?

“…Professional trust is regarded as critical for successful integrated support, requiring shared resources and unifying ways of communicating. However, mistrust remains common amongst HSC sectors (Kjellberg and Szucs, 2020). Different values and priorities across integration generate cultural lag as professionals struggle to "collaboratively define and re-shape" communication to meet contemporary community self-directed needs (Scottish Government, 2020).…”