Tending to innovate in Swedish primary health care: a qualitative study

Abstract

BackgroundPolicymakers in many countries are involved in system reforms that aim to strengthen the primary care sector. Sweden is no exception. Evidence suggests that targeted financial micro-incentives can stimulate change in certain areas of care, but they do not result in more radical change, such as innovation. The study was performed in relation to the introduction of a national health care reform, and conducted in Jönköping County Council, as the region’s handling of health care reforms has attracted significant national and international interest. This study employed success case method to explore what enables primary care innovations.MethodsFive Primary Health Care Centres (PHCCs) were purposively selected to ensure inclusion of a variety of aspects, such as size, location, ownership and regional success criteria. 48 in-depth interviews with managers and staff at the recruited PHCCs were analysed using content analyses. The COREQ checklist for qualitative studies was used to assure quality standards.ResultsThis study identified three types of innovations, which break with previous ways of organizing work at these PHCCs: (1) service innovation; (2) process innovation; and (3) organizational innovation. A learning-oriented culture and climate, comprising entrepreneurial leadership, cross-boundary collaboration, visible and understandable performance measurements and ability to adapt to external pressure were shown to be advantageous for innovativeness.ConclusionsThis qualitative study highlights critical features in practice that support primary care innovation. Managers need to consistently transform and integrate a policy “push” with professionals’ understanding and values to better support primary care innovation. Ultimately, the key to innovation is the professionals’ engagement in the work, that is, their willingness, capability and opportunity to innovate.Electronic supplementary materialThe online version of this article (10.1186/s12913-019-3874-y) contains supplementary material, which is available to authorized users.

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“…The study is an expansion of an ongoing collaboration between three partners: Jönköping University, Bräcke diakoni (BD), and Region Jönköping County (RJC). Also, the study has its starting point in a framework that was developed in a previous study on innovations at successful primary health care centres in Jönköping County [19]. The collaborating health care organizations have a long track record and experience of similar development strategies based on continuous quality improvement in everyday work combined with a strong value base focused on the needs of patients [35].…”

“…Also, the members tested and verified the needs identified with their colleagues. In this step, the following question is addressed: What do the local processes for knowledge use and knowledge development look like and how may the intervention align with these?Enriched with the results from steps 1 and 2, the intervention was crafted and structured based on the four preconditions identified in Avby et al [19]. At this stage, the intervention will also be tested, which will greatly increase the activity at the participating health care centres and involve the entire staff.…”

“…Although innovation in the public sector is a relatively new field [14–16], the quality improvement paradigm has been a forerunner and parallel management model of public sector innovation [17, 18]. Studies show that innovations are supported by a strong culture and climate of learning and collaboration [19], and a receptive capacity for new knowledge [20]. Most innovations are actually outcomes of combinations; that is, integration of diverse forms of knowledge and interaction when people with different backgrounds meet [16, 21].…”

“…Three previous studies of well-functioning primary health care centres in Sweden (in the same region in which this study takes place) showed that professionals were provided with time and space for quality improvement work and that they worked to coordinate their efforts through non-hierarchical relationships and collaborative teamwork [19, 34, 35]. The studies established that professional autonomy was highly valued, sustained and maintained through delegation of responsibility, trust, support and feedback; and that healthy work environments, such as accessible and fair leaders, skilled communication, collaboration/teamwork, employee involvement, and good relations with stakeholders, contributed to the development of a well-functioning health care centre.…”

“…The studies established that professional autonomy was highly valued, sustained and maintained through delegation of responsibility, trust, support and feedback; and that healthy work environments, such as accessible and fair leaders, skilled communication, collaboration/teamwork, employee involvement, and good relations with stakeholders, contributed to the development of a well-functioning health care centre. Conditions that provided a fertile ground for innovations were a culture and climate of managing learning, combined with the ability to monitor performance, adapt to external requirements, and collaborate with others [19].…”