Sammen hver for sig: En systemteoretisk analyse af projekt Sundhedsstrategisk ledelse af det nære sundhedsvæsen

Abstract

This thesis addresses the topic of cross-sectorial cooperation in the Danish healthcare system. Through a case study of a project about strategic healthcare management of the ‘near’ healthcare sector in Region Midtjylland, the thesis investigates how cross-sectorial cooperation can take new forms through the emergence and stabilisation of a network system. A system that we find has the ability to fill the organisational gap between the sectors. The analyses are framed by Niklas Luhmann’s Systems Theory. In this constructivist perspective the social is contingent, which indicates that whatever organisations do to solve existing problems, it raises new questions. This perception serves as the outset for the study of cross-sectorial cooperation. The analyses are empirically based on field observations, interviews and documents. Our analyses show how a discrepancy between the conditions for and the semantics of cross-sectorial cooperation gives room for organisational change. It is within this context, the project in Region Midtjylland is to be found. By developing cross-sectorial relations as well as new models for treatment, the organisations create a third order system that enables them to engage in decision making, which exceeds organisational boundaries, while the participants still remain independent organisations. Thereby, the third order system thus offers flexible ways of cross-sectorial collaboration. However, the project finds itself in a range of conflicting expectations of cooperation and is limited by the present procedures and organisation of the healthcare sector. Thus, responsibility concerns arise and third order solutions are threatened by organisational boundaries and separation of tasks and responsibility. We conclude that third order network systems can be an answer to the organisational difficulties in co-operation. The issue is, however, not to make strategies for maintaining responsibility boundaries, but rather to create space for joint decision making. The contribution of this thesis is twofold; we present new knowledge about network-based cooperation in the ‘near’ healthcare sector across municipalities, hospitals and general practitioners. At the same time the thesis further develops the concept of third order systems by applying it to a new empirical context.