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The purpose of this paper is to identify and describe main obstacles for politicians when dealing with healthcare priority setting.

The study had an exploratory descriptive design based on interviews with 18 politicians from two different county councils in Sweden. The interviews were analyzed using inductive qualitative content analysis.

The politicians highlighted the importance of, and difficulties in, communicate political missions; the politicians in this study saw the media as not always being fair watchdogs, implying that possibly important but unpopular prioritizing decisions were not made because of the risks of being badly reported and therefore not re-elected. Breaking up established structures in care practice is difficult and change takes time, partly because of existing higher level financing and rules and the system’s traditional separation of facilities and services. Although the politicians highlighted their limited power to influence and control resource allocation they could give small and “lower profile”, low-prioritized disciplines control of their own budgets and base payments on the results the disciplines accomplished.

This study highlights the difficulties that politicians experience, for example, having to take unpleasant decisions and thereby run the risk of being scrutinized by media, which in turn could influence how effectively tax money is being used.

This chapter examines the developmental journey toward a sustainable healthcare system in the west of Skaraborg County in Sweden from 2000 to 2010. It tracks a stream of collaborative research projects within the context of the Swedish sustainability debate that were focused on achieving improved care quality, patient safety, efficiency, and efficacy. The case reports how a central government directive to integrate healthcare at the local level – the county – led to the establishment of a development coalition management group that designed and managed the transformation via broad participation and engagement mechanisms. The transformation process toward a more sustainable healthcare system raises theoretical and practical questions about sustainable effectiveness, the role of partizcipation and learning mechanisms such as democratic dialogue conferences in sustainable effectiveness, the tension between planned and emergent change processes, and the challenge of integration in the drive toward a sustainable healthcare system.

This chapters discusses the power structures affecting access to healthcare and the quality of received care including factors like gender, ethnicity, social and economic status among others from an intersectional perspective. Structural changes are necessary to decrease the health inequalities and vulnerabilities during the pandemic. An intersectional approach helps to display the interactions of different power structures and social categories which put people at differential risk of infection and/or mortality of COVID-19. The intersectional approach should be used not only to understand the pandemic impact on people but also when planning the healthcare policies, care plans and support services.

The aim of this study is to describe the view of age‐related prioritisation in health care among physicians and healthcare politicians and to compare their views regarding gender and age.

Swedish physicians (n=390) and politicians (n=310), mean age 52 years, answered an electronic questionnaire concerning age‐related priority setting in healthcare. The questionnaire had fixed response alternatives with possibility of adding comments.

A majority of the participants thought that age should not influence prioritisation, although more physicians than politicians thought that younger patients should be prioritised. There were also significant differences concerning their views on lifestyle‐related diseases and on who should make decisions concerning both vertical and horizontal prioritisation. The comments indicated that the politicians referred to ethical principles as a basis for their standpoints while the physicians often referred to the importance of biological rather than chronological age.

Web‐based surveys as a method has its limitations as biased samples and biased returns could cause major problems, such as limited control over the drop‐outs. The sample in this study was, however, judged to be representative.

The results indicate that supplementary guiding principles concerning prioritisation in healthcare are needed in order to facilitate decision‐making concerning resource allocation on a local level.

This paper adds important knowledge about decision makers' views on age‐related priorities in healthcare, thus contributing to scientific base for prioritisation in healthcare and the ongoing debate in society.

The purpose of this paper is to analyse ethical competence related to healthcare governance and management tasks at the county/regional level in Sweden. The paper also discusses conditions that support or constrain the development and application of such competence.

The study is based on original qualitative data from 13 interviews and 6 meeting observations. Three key groups of actors were included: politicians, civil servants and CEOs in publicly financed health-provider organizations. An abductive analysis was carried out by a stepwise method guided by thematic research questions.

The informants viewed themselves as having a high degree of ethical responsibility for healthcare practice. However, they did not integrate ethical reflection and dialogue into their work decisions (e.g. regarding budgets, reforms and care agreements). The current organization, control systems and underlying business principles, along with the individuals’ understanding of their own and others’ roles, tended to constrain the development and use of ethical competence.

Qualities of an appropriate ethical competence related to healthcare governance and management, and conditions to develop and use such competence, are suggested.

Hardly any empirical research has examined ethical competence related to healthcare governance and management tasks. The paper integrates ethics and theories on learning in organizations and contributes knowledge about ethical competence and the conditions necessary to develop and practise ethical competence in an organizational and inter-organizational context.

The purpose of this paper is to examine the role of accreditation documents (ADs) in the competition based on provider quality in a quasi-market for primary healthcare.

The paper uses a mixed-method research methodology to analyse two primary healthcare ADs in two Swedish regions. In total, 19 interviews were conducted with actors involved in the creation and use of such documents.

This paper points to the crucial role of ADs in the identification of quality differences that influence the competition in primary healthcare. This finding contrasts with the commonly held laissez-faire idea that competition causes providers to develop their own service concepts and where the invisible hand creates quality differences. The paper adds to the discussion with its detailed description of how ADs create competition among primary healthcare providers through selection processes, quality differentiation, and ranking.

The paper does not explore quality differences in the medical treatment of patients in primary healthcare centres.

The paper provides insights for politicians on how to use ADs to control competition and regulate choice.

The paper takes an innovative approach to the examination of how ADs increase the competition in primary healthcare choice.

The rate of turnover of hospital managers has been high in Sweden. Hospitals are regarded to be difficult to manage, which is connected with different discourses and action logics such as politics, medicine, care and management creating complex conditions for hospital management. The purpose of this paper is to analyse hospital managers' management conditions in conjunction with hospital mergers.

Two case studies concerning hospital mergers illustrate these management conditions by means of analysing how different actions are communicated by politicians, county council directors, and hospital managers. The author's own experiences as a hospital manager have been made use of, as have document studies. In the analysis, conducted with the support of several theoretical perspectives, certain themes emerge which touch upon these management conditions.

In connection with hospital mergers, leading hospital actors carry out communicative games controlled by different action logics. No one wants to get stuck with the losing card. The article demonstrates the difficulties of implementing radical organizational changes in hospitals. A challenge for hospital managers lies in creating a shared dialogue and a consensus with the professions, the politicians and the media. The crucial position of power held by the politicians and the professions in critical situations has to be dealt with. Otherwise the hospital manager has to resign.

The paper aims to clarify under which management conditions the hospital manager acts.

Research was conducted to investigate whether, and how, political accountability might stabilise when agents are faced with profound changes in external structures such as competition laws and austerity policies.

We performed a field study from 2007 to 2015 in a regional hub in Finland and worked with data from document analysis, interviews and meeting observations. We have used embedded research design, where we apply methodological bracketing as well as composite sequence analysis for field research.

Accountability declined when irresistible external structures were the dominant influence on the unreflective actions of agents-in-focus. With time, however, the agents started acting critically by drawing on structures that could facilitate strategic actions to stabilise political accountability.

The field research and interpretation of the data were limited to the organisation analysed; however, the theoretical arguments allow for analytical generalisations.

The research demonstrates how public officials and political decision-makers can eventually adopt a strategic approach when faced with irresistible change in external structures.

The research demonstrates how public officials and political decision-makers can eventually adopt a strategic approach when faced with irresistible changes in external structures.

The study locates political accountability in the context of strong structuration theory and discusses how it is redefined by external structures.

This paper seeks to report the findings from a seven‐year study on the UK National Health Service on the introduction of an electronic health record for 50 million citizens. It explores the relationship between policy and practice in the introduction of a large‐scale national ICT programme at an estimated value of £12.4bn.

Using a longitudinal research method, data are collected on the policy‐practice nexus. The paper applies institutional theory using a conceptual model by Tolbert and Zucker on the component processes of institutionalisation.

The findings suggest that institutional forces act as a driver and an inhibitor to introducing enabling technologies in the health‐care environment. A process analysis shows that, as electronic health records force disruptive change on clinicians, healthcare managers and patients, culturally embedded norms, values and behavioural patterns serve to impede the implementation process.

This research is limited in its generalisability to national, regional and local ICT implementations due to the complexity of the policy and practical issues at stake. Despite the longitudinal research approach, the use of institutional theory can only offer a flavour of how institutionalised values, norms and behaviours influence health IT policy and practice.

The paper demonstrates the complexity of translating centralised ICT policy in healthcare to practical solutions for clinicians and other stakeholders. It shows how a large‐scale ICT programme based on procurement of technology is unlikely to succeed where important issues of user engagement and a sound “business case” have not been achieved.

This research contributes to the theoretical literature on institutionalism by addressing the dichotomy between institutional and technical environments. While technology is often discussed in isolation of an institutional process, it may become embedded in organisational practices, reaching a process of sedimentation (institutionalisation) or fail to take hold and fade from view.

The purpose of this paper is to explore and describe online communication about the experiences and attitudes toward Swedish Healthcare Direct, a national telephone advice nursing (TAN) service.

A descriptive research design was adopted using a six-step netnographic method. Three Swedish forums were purposefully selected and data from the virtual discussions were collected.

Three themes emerged: expectancy and performativity of the nurses, absurdity in accessibility and the scrutinizing game. The most prominent finding was the scrutinizing game, which included aspects of bidirectional mistrust from both nurses and callers. Another salient finding was the attitudes that callers held toward nurses who used a technique interpreted as “passing the buck.”

The use of a nethnographic method is novel in this area of research. Consequently, the body of knowledge has regarding telephone advise nursing service has significantly been broadened. A limitation in this study is that demographic data for the posters are not available.

Bidirectional distrust is an important issue that must be acknowledged by TAN services, since it might damage the service on a fundamental level. Healthcare providers, politicians, and researchers should account for the power and availability of virtual discussions when seeking consumers’ opinions and evaluating the quality of the care provided.

This analysis of the ongoing discussions that take place on the internet provides insight into callers’ perceptions of a national TAN service. The bidirectional mistrust found from both the nurses and the callers might be a threat to callers’ compliance with the advice given and their care-seeking behavior.