Kunsten at koordinere

Edda Heinskou & Mette Molin

Student thesis: Master executive thesis

Abstract

The overriding starting point for the master’s dissertation is the development in the local health care service, more specifically the coordination that takes place in the cooperation between the assessment unit, homecare and short-term rehabilitative stays, when the municipality receives citizens returning from concluded hospital stays. Our problem statement is: How is the citizens Care Package coordinated in Furesoe and Fredensborg municipalities across the three units; assessment unit, short-term rehabilitative stays and homecare? We have chosen to take a theoretical starting point in the theory of Henry Mintzberg concerning different configurations of structure. In his research, Mintzberg focuses on how different types of organization is most effective and most prevalent in different types of surroundings. We apply Mintzbergs typology as a conceptual frame for our analysis of what coordination mechanisms and forms of organization appears. We have supplied Mintzbergs theory with Gittell and Douglas’ theory of relational bureaucracy, in order to better pin down the coordination that takes place through personal-based relations. While Mintzberg looks at mechanisms of coordination and forms of organization, Gittell and Douglas investigates the relations and balances along with the more bureaucratic structures that can embed these. In our methodical approach we have chosen a case study design based on its strength in relation to embed the social process as well as the social complexity that lies embedded in the social systems, including its dependency of the surroundings. We have chosen two different municipalities as case studies, Furesoe and Fredensborg, because these two does quite well, on many of the parameters of elder care and health areas the municipalities are measured by. In our analysis, we have chosen interviews, individual as well as group-based, as our primary empirical tool. For our secondary empirical tool, we have included selected documentation from the two municipalities. Furthermore, we have chosen a thematic method of analysis that stems from the chosen theoretical assumptions as well as from our problem statement. In this way, we are talking about a deductive thematic analysis where we view data through a theoretical lens, making the chosen theories define the coding and the thematic development. In the light of the analysis, we can conclude that, in this context, both municipalities are hybrid structures and therefore apply many different coordination mechanisms and structures in the process of coordinating the cooperation between the three units. At first glance it makes good sense, seen in light of the development in the primary health sector, where the municipalities sees an increase in tasks of a certain complexity over the years. It is interesting, however, that the municipalities in focus does not favor one specific configuration, as Mintzberg suggests, but perhaps to an extent manages to navigate in several at once. The question is though, whether the effective organization, considering the speed the overlying health sector, and thereby the municipalities’ role in it, develops within recent years, is an organization that favors one configuration or organizational form over another, or an organization that manages to navigate smoothly between different. It seems to be what our analysis indicates. Furthermore, our analysis indicates both common tendencies as well as a series of differences. Common tendencies: • Standardization of “skills” and “mutual adjustment” as dominant coordination mechanisms. • A focused coordination between assessment units and the short-term rehabilitative stays. • Individual strong person-based relations. • Structures such as training for relational competence and a strong mutual responsibility towards the economic frame which again embeds the person-based relations. Differences: • Different use of the coordination mechanism the standardization of “work processes”, most clearly present in Fredensborg, less in Furesoe. • Differences in use of other structures, eg. Furesoe uses a relational job design across demarcation lines while cross-roll meetings with relational space are far more prevalent in Fredensborg. An important conclusion is therefore also a consideration that, besides the common tendencies, an array of contextual factors also determines the balance in forms of coordination and structures

EducationsMaster of Public Governance, (Executive Master Programme) Final Thesis
LanguageDanish
Publication date2019
Number of pages71
SupervisorsMorten Knudsen