"Öppna jämförelser"- morot eller piska?
En fallstudie av hur förändrad styrning av sjukvården påverkar läkare i deras yrkesutövning
The governance and control of healthcare organizations has traditionally been run byprofessions inside the organization (Fölster et al., 2003). During the last decades Swedishhealthcare has undergone an institutional transformation where the governance has changedfrom professional governance to a more market like one (Sahlin-Andersson, 2006). Governingof healthcare can however be problematic as professional work is characterized by a highlevel of autonomy and tacit knowledge (cf. Tsoukas, 1997, Freidson, 2001). An expression ofthe new kind of governance is the annually published report ?Öppna jämförelser av hälso- ochsjukvårdens kvalitet och effektivitet?. The report measures and ranks the quality of Swedishhealthcare. The purpose of this thesis is to describe if, and in that case how, doctors in theexercise of their profession are affected by governance through ?Öppna jämförelser?. Thestudy was carried out as a qualitative case study where six doctors from two different clinicswere interviewed.The results from this study show that ?Öppna jämförelser? does not affect doctors in theexercise of their profession to a large extent. It does however contribute to increasedprofessional knowledge. Audit and ranking is also seen as a ?carrot? to perform better. As atool to measure and rank the quality of healthcare, ?Öppna jämförelser? needs to be developand improved. The doctors argue that the measured indicators are blunt and that they do nothave any influence in what is being measured. ?Öppna jämförelser? is however perceived as agood initiative but would get more meaning for the doctors in the exercise of their professionif more and also other indicators would be included.