Governments around the world have been increasingly adopting an ‘outcomes-focus’ in the design of policy and the management of public services, the implications of which have been subjected to increasing scrutiny within public administration (Boyne and Law 2005; Elvidge 2012; Heinrich 2002; Housden 2016; Lowe 2013; Lowe 2017; Wimbush 2011). Yet wherever an outcomes-based approach has been applied, be it within performance management (Bevan and Hood 2006; Lowe 2013; van Thiel and Leeuw 2002), budgeting (Perrin 2006; Ryan 2003), or commissioning, its achievements have fallen short of expectation (Wimbush 2011). Outcomes have predominantly been conceptualised and operationalised within what this thesis calls a ‘Rationalist’ approach, linked to the New Public Management context within which an outcomes-focus was popularised. This approach assumes we can understand the factors which drive outcomes, plan appropriate service interventions, harness the resources and commitment needed to put such interventions into practice, and manage such interventions towards their expected end points. Outcomes however are inherently complex phenomena – they are always transboundary, always co-produced by the individuals who experience them, and always impacted by a large number of unpredictable and uncontrollable factors in their external environment. Public management theory and practice finds itself at a crossroads: an imperative to improve outcomes, and a paradigmatic inability to do so – a challenge which scholarship is just beginning to respond to (Housden 2016; Lowe et al. 2016). This thesis contributes an alternative ‘Complex Systems’ theoretical framework which responds to (rather than simplifies or externalises) the inherent complexity which outcomes present. This theoretical framework draws on complex adaptive systems theory to enable a ‘Complex Systems’ approach to the management of outcomes. The framework is based on the conception of outcomes as emergent products of complex systems, and integrates three defining components of complex adaptive systems (self-organisation, distributed agentic learning, and attractor states) to enable an endogenous process of service transformation in conditions of uncertainty. This theoretical framework provides public management with more solid footing for understanding, analysing and designing outcomes-focussed interventions, with distinct advantages relative to existing outcomes-based approaches, in pursuing complex public service outcomes. The thesis applies this framework through a multiple embedded case study analysis (Yin 2009) of the Early Years Collaborative, a large-scale multi-agency Quality Improvement Collaborative operating across Scottish local authorities, as it seeks to improve a set of population-level child development outcomes.

Sammanfattning Under år 2018 tog 1177 Vårdguiden emot tre miljoner samtal från hela Sverige. I Västra Götaland tog de emot 900 750 samtal och ungefär 33 procent av dem handlade om barn. Genom telefonrådgivningstjänsten kan föräldrar till barn som råkat ut för sjukdom eller skada ringa 1177 Vårdguiden och få medicinsk rådgivning av en sjuksköterska. Begreppet samskapande omvårdnad är av betydelse då samverkan och en god relation mellan patient och vårdare bidrar till hälsa. Syftet med studien var att beskriva hur sjuksköterskorna som ger telefonrådgivning genom 1177 upplever rådgivning till föräldrar med sjuka barn. En kvalitativ metod användes och semistrukturerade intervjuer utfördes med tolv stycken sjuksköterskor som sedan analyserades efter en induktiv innehållsanalys på manifest nivå utifrån Elo & Kyngäs (2008). Två stycken huvudkategorier bildades i resultatet: Vikten av att stärka föräldrarna i föräldrarollen; där sjuksköterskorna som ger telefonrådgivning försökte skapa förtroende till föräldern, genom att bekräfta föräldern samt genom att förmedla kunskap och information. Kommunikationens utmaning vid telefonrådgivning; där sjuksköterskorna som ger telefonrådgivning upplevde svårigheter i att bedöma symtom på barnet, när föräldrar hade svårt att beskriva barnets symtom och när det förekom bristande språkkunskaper. Konklusionen visar att sjuksköterskorna som ger telefonrådgivning hade en betydelsefull roll för föräldrarna genom att vara stöttande vilket ökade deras självförtroende. / Summary In 2018, 1177 Healthcare guide received three million calls from all over Sweden. In Västra Götaland they received 900 750 calls and about 33 percent of them concerned children. Through the telephone call advice centre, the person or parent of children who has suffered from illness or been injured can call 1177 Healthcare guide and get medical advice from a nurse over the telephone. Co production healthcare is important as cooperation and a good relationship between patient and carer contribute good health. The purpose of the study was to describe how the nurses who give telephoneadvice through 1177 experience giving advice to parents with ill children. A qualitative method was used and semi-structured interviews were conducted with twelve nurses, which were then analyzed using a qualitative inductive content analysis with a manifest content based on Elo & Kyngäs (2008). Two main categories were formed in the result: The importance of strengthening parents in the parent role; where the nurses who give telephoneadvice  try to create trust in the parent, by confirming the parent and by giving medical advice and information. Communication challenge in telephone advice; where the nurses who give telephoneadvice experienced difficulties in assessing the child’s symptoms, as well as when parents had difficulty describing the symptoms and when there was a language barrier. The conclusion of the study was that the nurses who give telephoneadvice played a significant role for the parents by being supportive which increased their self-confidence.

This Master's Thesis called "Climate expertise and security politics: the case of the Czech Republic" deals with engagement of climatologists in politics and society. Nowadays, certain actors (politicians, activists, celebrities, etc.) perceive climate change as dangerous threat to humanity, and so, they try to securitize this issue. They endeavor to inform ordinary people and make politicians to adopt extraordinary measures. Among these securitizing actors, we could find several climatologists who can fulfil role of security experts. However, such a trend is not present in the Czech Republic. Czech climatologists are not so active publicly and in politics compared to their foreign colleagues. This Thesis would like to analyze what are structural conditions of this trend. It is focused on various influential elements - society, politics, media and scientific field itself. It is based on concept of co-production that is about mutual relationship between these elements. It shows that society, politics and media are rather discouraging Czech scientists from engagement. However, also scientific community as such is not coherent, but there are several different epistemic communities. This Thesis would also like to connect science with Security Studies, mainly securitization theory and security...

Together with a steadily increasing urban population, South Africa and the city of Cape Town is facing continuously expanding informal settlements and communities with no access to basic human services or adequate housing. There’s an urgent need to design, plan and implement alternative and creative approaches to help stimulate an equal, inclusive and sustainable urban development and strategic spatial planning. Integrating methods and processes that includes participation, communication and collaboration by incorporating civil society and local community members in urban planning practices is one way of promoting sustainable and equal spatial growth. Co-production is a concept used in urban development theory that embraces this in and can be described as a communicative form of spatial planning where state, planners and citizens mutually interact in the planning process. In consideration of these challenges, this thesis aims to apprehend how marginalized, local communities in Cape Town can be included in matters regarding urban development and spatial planning practically and if co-production can be used to define and explain this form of approach. Therefore, this thesis is based on a case study research of the Better Living Challenge (BLC) incubator, a two-week long project in Cape Town, which supported 15 informal builders in improving and developing their designing, building and marketing skills. The practical implementation of this incubator and its process has been examined to determine if the theory of co-production can be used to outline the project and understand the results emerging from it. The incubator proved to be successful in several ways and was met with impressive feedback from the stakeholders. It was also followed with difficulties and restrictions like power dynamics and tension. The conclusions that were made highlights that the incubator can be defined as an alternative and unorthodox co-productive approach based on the aim and lay-out of the process.

本研究は、従来の制度的支援における「狭間」問題に着目し、その解決に寄与する「協働モデル」という新たな支援戦略を理論的・実証的に提示することを目的としている。こうした新しい支援戦略の提示を通して、第1に、「協働」という概念を社会サービスの多元性を理解する一つの基礎理論の視座として形成すること、第2に、「狭間」問題の解決、および社会サービスの促進における「協働」の具体的な機能とメカニズムを明確にすること、を目指している。 / 博士(社会福祉学) / Doctor of Philosophy in Social Welfare / 同志社大学 / Doshisha University

Svensk patientlag fastställer att patienter med stort vårdbehov ska ha en fast vårdkontakt (FVK). Inom ramen av god och nära vård ska FVK erbjudas till dessa patienter. FVK förutsätter att vårdpersonalen antar ett personcentrerat arbetssätt och upprättar en hälsoplan i samskapande med patienten. I kontrast upplever sjuksköterskorna att de saknar stöd och kunskap om arbetssättet FVK. Detta leder till att patienterna känner sig otrygga, är frekvent vårdsökande och träffar olika vårdpersonal. Syftet var att förbättra trygghet och kontinuitet för patienter listat på en vårdcentral i Dalarna genom att erbjuda FVK till dessa patienter. Det specifika målet var att erbjuda tolv patienter en FVK inklusive hälsoplan inom sex månader samt att förbättra sjuksköterskornas kunskap om arbetssättet FVK. Syfte med studien var att evaluera om patienter ansåg att deras vårdbehov tillgodoses genom arbetssätt FVK och beskriva sjuksköterskorna erfarenhet av arbetssättet. Förbättringsarbetet inkluderade Nolans’ förbättringsverktyg, patientinvolvering och kunskapshöjande insatser för sjuksköterskor. För att undersöka hur arbetssättet FVK upplevs av patienter och sjuksköterskor genomfördes en mixad-metodstudie. En enkät riktat till patienter utformades och tre fokusgruppintervjuer, en dyad och en enskild intervju med sjuksköterskorna genomfördes. Inom sex månader hade tolv patienter en FVK tilldelad varav tio patienter hade en hälsoplan. Patienterna uttryckte att deras vårdbehov tillgodoses genom arbetssätt FVK vilket stämmer överens med sjuksköterskornas uppfattning att deras patienter söker mindre vård. FVK ökar trygghet och kontinuitet för patienter med stort vårdbehov under omständigheter som tillåter sjuksköterskorna att anta personcentrerat arbetssätt. Patienterna upplever att deras vård förbättrats och sjuksköterskorna att arbetssättet FVK ger mer värde. Studien var småskalig och begränsat till en mindre vårdcentral vilket limiterar dess överförbarhet till andra verksamheter och fler studier behövs. / The Swedish Health law obliges healthcare centers to assign case managers for patients in need. Good quality in local health care thus includes providing case managers. The case manager method presupposes that care staff adopts a person-centered manor and creates care in co-production with the patients. In contrast the nurse lacks support and knowledge to provide case management. This results in patients feeling insecure, seeking frequently for health related afflict and meeting various caregivers. To improve safety and continuity for patients in need one healthcare center in the county of Dalarna has decided to provide case management for patients assigned to the center. The specific goals were to assign twelve patients to a case manager, including health care plan within six months, and to increase knowledge for nurses. Aims of the study were to describe patients’ perception whether they consider if their needs are accommodated by the case manager, and nurses’ experiences to work as a case manager. Nolans’ improvement tool was used involving patients in their care as well as training nurses in case management skills. To study the effect of case management on patients and nurses a mixed-method design was conducted. A patient questionnaire was performed and three focus group interviews, one dyad and one individual interview with nurses were conducted. Twelve patients were assigned a case manager after six months. Ten patients had an established care plan. The patients expressed that their need of care was accommodated which is in coherence with the nurses who described that their patients were in less need for care. Case managers improve safety and continuity for patients in need under circumstances that allow nurses to develop person-centred manor. Patients expressed care improved and nurses increased work values. Yet this survey was limited to a small unit and further studies are needed.

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This project is an exploration of co-produced space in a city planning process. With the intention of exploring participatory design processes in the field of spatial design, this project is focusing on co-production of space and the role and power of the architect as a relational and spatial initiator. Since participatory design processes have become an implemented tool in municipal city planning, it is of relevance from a perspective of interior architecture to through practical work be both specific, aware and transparent about how these processes could be designed.  The project takes place in a public park in Gottsunda, a district south of Uppsala, built as a part of the Swedish million programme in the 1960’s- and -70’s. Gottsunda is now undergoing a city planning transformation and expansion. With background of city planning and architecture from that time, this project has been seeking knowledge of what relevance participation plays in city planning today.  This project has been conducted through a series of spatial activities at site, historical research and meetings with a group of teenage girls living in Gottsunda.  The conclusions and implications of this project are that the interior architect’s tools as tactile and close to both object, places and users, in this case residents, are of relevance in city planning. Participation is relational, and the interor architect's ability is to both design, understand and translate those relations into the practice of spatial design. / <p>Bilder har tagits bort i enlighet med upphovsrättslagen.</p>

The emergence of energy communities entails the development of alternative energy systems, where consumers become active participants in the complex networks of material and semiotic actors. This paper looks at how local sociotechnical imaginaries are performed on island of Gotland, in Sweden. Grounded in Science, technology and society studies and co-production theory, this study provides a framework analysis of a set of documents and an interview, through the identification of conflicting visions, or sociotechnical imaginaries, of energy transition locally. The Swedish energy system is adapting slowly to the changing environment, and conflicts have emerged between national and local imaginaries. Here, the literature fails to provide satisfying arguments around political processes leading to the creation of alternative visions of energy futures. This study shows how normative orientations shape and are shaped by each other, and how alternative visions of progress often fail to be actualized and performed as long as they exist in combination with dominant visions. The two imaginaries, on one side the dominant, on the other the radical, fail to come to terms with each other because of the structural inadequacy of a system dominated by a political rationality which is unaware of itself.