Syftet med den här avhandlingen är att undersöka utvecklingen av kvalitetssystem i hälso- och sjukvården ur ett historiskt-institutionellt perspektiv utifrån fallstudier och konceptuella analyser. Särskilt analyseras implikationer av utvecklingen med avseende på relationen mellan den medicinska professionen och det politiskt administrativa systemet samt konsekvenser för den politiska styrningen av sjukvården. Studien visar att medicinska kvalitetssystem och därmed även den medicinska professionen bäddats in i den politiska styrningen i takt med att ambitionerna mot en offentlig kunskapsstyrning tilltagit. Den visar även att hälso- och sjukvårdens kvalitetsregister i olika faser av sin utveckling har påverkats av politiska ideologier, managementidéer och idéer om transparens. Öppna jämförelser som en oavsiktlig konsekvens av kvalitetsregisteranvändningen förstärker dessutom tendensen mot en offentlig kunskapsstyrning. Av studien framgår också att den offentliga kunskapsstyrningen utmanar föreställningen om demokratiidealet om upplyst förståelse. Den ökade fokuseringen på kunskapsstyrning inom hälso- och sjukvården gör det relevant att ställa frågan vem som styr vem i svensk hälso- och sjukvård, vilket i sig är en fråga om demokrati och legitimitet. / The aim with this thesis is to describe the quality development in Swedish healthcare from an institutional perspective, analyse implications of the development concerning the relationship between the medical profession and the public administrative system and discuss consequences for political direction and welfare organization. The study is based on four case studies and one conceptual analysis. The main conclusion is that the medical quality systems have been imbedded in the political management alongside the development towards a public knowledge management. The analysis has more specifically uncovered that quality registries in healthcare have been influenced by political ideologies, management ideas and ideas of transparency. It is also clear that open comparisons were an ‘unintended consequence’ of the quality registry development that has enhanced the development towards a public knowledge management. The analysis also shows that public knowledge management challenges the ideal of democratic enlightened understanding. The development of public knowledge management in the healthcare sector raises the question of who is governing whom in Swedish healthcare.

The research attempts to explain the character of Malaysia’s political economy. By adopting a historical institutional analysis it explains that British colonial administration persistently made rational choices within a short-term horizon that encouraged the growth of two autonomous groups – Malays and Chinese - whose political, economic and social organisation, at the point of Malaya’s independence in 1957, had made it inevitable for them to embark on some form of consociational arrangement. British policies engendered two processes; first, a less-than-full incorporation of Chinese as new actors in Malaya’s political economy and second, a less-than-full retrenchment of Malay political dominance by preserving Malay de jure power. In sum, British decision to preserve Malay de jure power while at the same time incorporate Chinese economic and political presence created two communities with mutually exclusive institutions that increasingly competed for access to political and economic resources. The self-reinforcing nature of these exclusive institutions and the flux that came with the demands for Malaya’s independence made it necessary for these two communities to attempt various institutional options that could best reconcile exclusive institutions and negotiate competing political and economic demands. Three institutional options were tried: consociationalism, integration and partition. The research will explain that among the three, the path-dependent nature of Malaya’s political economy had necessitated a particular institutional logic, the consociational logic. Integration failed because attempts to establish common institutions and do away completely with longstanding mutually exclusive ones proved over-ambitious. Partition also did not materialise as it proved politically and financially costly. In sum, the research highlights Malaysia’s consociationalism as a product of small incremental policy steps which proved to be no less transformational in the long run that gives Malaysia’s political economy a quite different character than it had had at the start of British official rule in 1874.

Por que uma instituição se estabelece com maior facilidade em um local do que em outro? Essa questão motiva o presente trabalho, que investiga em perspectiva comparada a criação da Defensoria Pública instituição concebida para prestar assistência jurídica nos Estados brasileiros a partir de um marco comum: a Constituição de 1988. A abordagem institucionalista deste estudo sustenta que, para explicar a questão enfrentada, é preciso direcionar o foco da investigação para a estrutura institucional e para os atores que compõem o sistema de justiça. Dessa maneira, a hipótese formulada e avaliada nesta pesquisa demonstra que arranjos institucionais implantados em certos Estados, antes de 1988, para desempenhar a assistência judiciária fixaram atores interessados na sua permanência, e isso dificultou a criação da Defensoria local. Esses arranjos institucionais conferiam a setores da Procuradoria-Geral do Estado e/ou a advogados particulares a função de atender juridicamente as pessoas pobres. Arranjos diferentes de assistência judiciária, presentes em outros Estados, produziram o efeito contrário, ou seja, estimularam certos atores a buscarem o desenvolvimento do modelo proposto pela Constituição. Em outras palavras, a implementação da Defensoria não ocorreu em terreno vazio, mas, ao contrário, teve que disputar o espaço já ocupado por outras instituições e atores no interior do sistema de justiça. Sua criação enfrentou constrangimentos maiores em alguns Estados por causa do tipo de arranjo institucional de assistência judiciária previamente existente. Veremos que essa abordagem, além de destacar o potencial do institucionalismo histórico para analisar mudanças institucionais do sistema de justiça, coloca em evidência o ativismo político de atores estatais como elemento central da explicação. Esse ativismo é essencial para compreender o desenvolvimento da Defensoria Pública no Brasil. / Why does an institution take root more easily in one place than in other? This issue motivates the present study, which investigates in a comparative perspective the creation of Public Defenders Office an institution designed to provide legal aid in the Brazilian States, considering the existence of a common legal base: the Federal Constitution from 1988. The studys institutionalist approach argues that, to explain the question addressed, it is necessary to direct the researchs spotlight to the structure and actors, which composes the justice system. Thus, the developed and evaluated hypothesis shows that institutional arrangements embedded before 1988 in certain States to promote legal aid have set some actors interests in the status quo maintenance, and that hampered the creation of Public Defenders Office in such States. These institutional arrangements ascribed legal aid to State Attorney Generals departments and/or to private lawyers. There were different frameworks of legal aid in other States, which engendered the opposite effect, that is, they prompted some actors to seek to develop the model proposed by the Constitution. In other words, the Public Defenders Office was not implemented in emptiness; instead it had to contend for space within justice system that was already occupied by other actors and institutions. Its creation faced major constraints in some States because of the kind of earlier existing institutional arrangements for legal aid. We will see that this approach, besides highlighting the historical institutionalisms potential to analyze changes in Brazilian justice system, emphasizes the political activism of state actors as a key factor for the explanation. This kind of activism is essential to understand the development of Public Defenders Office in Brazil.

O núcleo desta dissertação é desenvolver um conceito de path dependence mais parcimonioso, coerente e útil, seja teoricamente ou em estudos empíricos. Neste sentido, o insight fundamental é que se partimos de uma conceitualização mais dinâmica, baseada mais em externalidades negativas do que em rendimentos crescentes, o conceito de path dependence pode ser inerentemente mais operacionalizável, robusto e ressoar melhor com a literatura e os estudos Institucionalistas Históricos. O conceito de path dependence pode também ser mais compatível com várias elaborações realizadas dentro do próprio Institucionalismo Histórico sobre questões como mudança institucional, mecanismos explicativos, complementaridade, idéias e agência, e, portanto, enriquecer-se graças aos mesmos. / The objective of this dissertation is to develop a more parsimonious, coherent and useful concept of path dependence, both theoretically and empirically. Its fundamental insight is that with a more dynamic conceptualization, based more in negative externalities than in increasing returns, the concept of path dependence can be inherently more robust and resonate better with the literature and Historical Institutionalist studies. The concept of path dependence can also be more compatible with several theoretical developments which have arisen within Historical Institutionalism regarding questions such as institutional change, social mechanisms, complementarities, ideas, agency and, therefore, to be enriched by them.

<p>The aim of this case study is to analyse cooperation mainly in issues related to water management in the area along the Miño river. The study focuses on the Spanish municipalities that limit with the river and that are in the border area with Portugal. There was a key issue which was discovered during the reading and analysis of data, a change of no cooperation to cooperation on the Spanish-Portuguese border. There was previously a political culture of no cooperation among the autonomous regions in Spain, which could have affected cooperation with the region of north Portugal. The fact the both countries have different administrative cultures could also impede cooperation. Nevertheless cooperation seems to have developed and in order to study this phenomenon the researcher uses a qualitative method and relies on a choice of institutional theories. This research studies how institutions affect cooperation in this particular case. The theories will analyse the impact of political institutions and the relation between institutions and individuals. They also help to identify how human behaviour affects processes and events.</p>

The aim of this case study is to analyse cooperation mainly in issues related to water management in the area along the Miño river. The study focuses on the Spanish municipalities that limit with the river and that are in the border area with Portugal. There was a key issue which was discovered during the reading and analysis of data, a change of no cooperation to cooperation on the Spanish-Portuguese border. There was previously a political culture of no cooperation among the autonomous regions in Spain, which could have affected cooperation with the region of north Portugal. The fact the both countries have different administrative cultures could also impede cooperation. Nevertheless cooperation seems to have developed and in order to study this phenomenon the researcher uses a qualitative method and relies on a choice of institutional theories. This research studies how institutions affect cooperation in this particular case. The theories will analyse the impact of political institutions and the relation between institutions and individuals. They also help to identify how human behaviour affects processes and events.

This dissertation investigates the labour migration from Southern Europe to Sweden, and the changes in Swedish immigration policy between 1960 and 1972. The first part of the dissertation examines the role of the state in shaping the migration streams from Southern Europe to Sweden. From the beginning of the 1950s to 1966, Sweden’s borders were relatively open, and this facilitated a significant amount of immigration. A system of unregulated individual labour migration developed, where foreign citizens could enter Sweden as tourists and thereafter look for work and obtain a work permit. For a significant period of time there doesn’t seem to have been any strong opposition to this laissez-faire system. This all changed during the 1960s, however, when the liberal immigration regulations were called into question. An important factor was that immigration increased dramatically in the mid-1960s. In addition, the national composition of the migration streams to Sweden changed during these years. Immigration from Yugoslavia, Greece and also from Turkey increased, while the number of immigrants from the Nordic countries diminished. In connection with the changing immigration pattern, certain actors, such as the trade unions and Sweden’s central employment authority, AMS, called for more restrictive immigration regulations. Demands from the trade unions and AMS led to a more stringent immigration control in 1966, and again in 1967, when a new Swedish immigration policy was introduced. Swedish research into changes in immigration policy during the 1960s often emphasizes the considerable influence of the trade unions on the policy shift. An argument put forward in this dissertation is that the intensification of immigration control not only reflected the demands of the trade unions, but that significant demands also came from within the state apparatus, and particularly from AMS. AMS was a relatively autonomous actor when the immigration regulations changed in 1966-1967, and its demands and knowledge regarding the influx of migrant labour made a significant contribution to the formation of the new immigration policy. The second part of the dissertation investigates how industrial companies have shaped the migration streams from Southern Europe to Sweden. Immigrants from Yugoslavia and Greece were often recruited in order to perform the heavy and subordinate work in the manufacturing industries that native workers had either avoided or left at that particular time. The dissertation attempts to explain this concentration of Southern Europeans in subordinate positions in the manufacturing industries. During the 1960s, Yugoslavs became the largest non-Nordic group in the migration streams to Sweden. How did Sweden become connected with this emigration country situated in the Mediterranean? A conclusion is that, to a great extent, the requirements and actions of industrial companies shaped the national composition of the migration streams to Sweden.

In this thesis I analyze semi-structured interviews I conducted with fifteen young French and American business students and professionals in order to uncover cultural models relating to work, while paying particular attention to the acceptance or rejection of neoliberal ideas. To contextualize the analysis, I first review the history of neoliberal ideology along with its arrival and political and institutional influence in both countries. In the U.S., the neoliberal transition was rapid and dramatic under the Reagan administration, which constitutes a critical institutional juncture and a shift in the dominant paradigm of governance. In France, in contrast, neoliberal policies have been implemented reluctantly and incrementally, suggesting traditional French values relating to the state and its role in regulating the economy remain largely intact. In line with these historical patterns, the Americans I spoke to primarily conceptualize work as a commodity, accepting the definition of work as defined in the market; while the French interviewees conceptualize work as personal fulfillment and occupational citizenship, emphasizing the human and psychological essence of work and the need for moral regulation of the market economy, perceived as immoral and anarchic. Overall, the Americans much more readily accepted neoliberal ideas and policy directives and towards which the French were far less welcoming. In particular, I argue that the traditional role of the French state as responsible for the wellbeing of its citizens presents a major obstacle to neoliberal ideology, historically on an institutional level as well as in the minds of the French interviewees.

The Common Agricultural Policy (CAP) in the European Union (EU) is one of the oldest fields of cooperation within the European Union. During the past decades the different Commissioners have made several proposals about changes in the CAP and many of them have not been passed but renegotiated. The present Commission has however published a report in 2011, which emphasizes that the CAP has three alternative ways to go in the future. This study aims to predict which one of these three alternative ways it is most likely that the CAP will take according to the historical institutionalist theory. When to be able to predict this text analysis is used. The analysis tools of the study are collected from the theory, which focuses on the conceptions: critical juncture, feedback effects, path dependency and sequencing. These tools as well as the theory are applied on the empirical material, which mainly consists of books about the earlier reforms and proposals from the Commission, academical journals and some reports. The analysis shows that the Luxembourg compromise can be seen as a critical juncture in the history of the CAP and this led to a path dependency, which is characterized by a decision-making procedure by consensus between the political institutions in the EU. The analysis also shows that most of the reforms regarding the CAP, are made with some sort of compromise or consensus (the Delors I budgetary package, the Mac Sharry reforms and so on). Therefore the conclusion of the study is that, from an historical institutionalist perspective, it is more or less possible for the CAP to go with any of the alternative ways that the Commission points out in the report. It is however most likely that the second way is the most prominent one. This is because that option emphasizes that major overhauls of the policy should be made, that the measures should be more targeted, and that the spending of the CAP should be more efficient. All of these changes have been made more or less during the history of the CAP and the institutional framework therefore allows this way.

Por que uma instituição se estabelece com maior facilidade em um local do que em outro? Essa questão motiva o presente trabalho, que investiga em perspectiva comparada a criação da Defensoria Pública instituição concebida para prestar assistência jurídica nos Estados brasileiros a partir de um marco comum: a Constituição de 1988. A abordagem institucionalista deste estudo sustenta que, para explicar a questão enfrentada, é preciso direcionar o foco da investigação para a estrutura institucional e para os atores que compõem o sistema de justiça. Dessa maneira, a hipótese formulada e avaliada nesta pesquisa demonstra que arranjos institucionais implantados em certos Estados, antes de 1988, para desempenhar a assistência judiciária fixaram atores interessados na sua permanência, e isso dificultou a criação da Defensoria local. Esses arranjos institucionais conferiam a setores da Procuradoria-Geral do Estado e/ou a advogados particulares a função de atender juridicamente as pessoas pobres. Arranjos diferentes de assistência judiciária, presentes em outros Estados, produziram o efeito contrário, ou seja, estimularam certos atores a buscarem o desenvolvimento do modelo proposto pela Constituição. Em outras palavras, a implementação da Defensoria não ocorreu em terreno vazio, mas, ao contrário, teve que disputar o espaço já ocupado por outras instituições e atores no interior do sistema de justiça. Sua criação enfrentou constrangimentos maiores em alguns Estados por causa do tipo de arranjo institucional de assistência judiciária previamente existente. Veremos que essa abordagem, além de destacar o potencial do institucionalismo histórico para analisar mudanças institucionais do sistema de justiça, coloca em evidência o ativismo político de atores estatais como elemento central da explicação. Esse ativismo é essencial para compreender o desenvolvimento da Defensoria Pública no Brasil. / Why does an institution take root more easily in one place than in other? This issue motivates the present study, which investigates in a comparative perspective the creation of Public Defenders Office an institution designed to provide legal aid in the Brazilian States, considering the existence of a common legal base: the Federal Constitution from 1988. The studys institutionalist approach argues that, to explain the question addressed, it is necessary to direct the researchs spotlight to the structure and actors, which composes the justice system. Thus, the developed and evaluated hypothesis shows that institutional arrangements embedded before 1988 in certain States to promote legal aid have set some actors interests in the status quo maintenance, and that hampered the creation of Public Defenders Office in such States. These institutional arrangements ascribed legal aid to State Attorney Generals departments and/or to private lawyers. There were different frameworks of legal aid in other States, which engendered the opposite effect, that is, they prompted some actors to seek to develop the model proposed by the Constitution. In other words, the Public Defenders Office was not implemented in emptiness; instead it had to contend for space within justice system that was already occupied by other actors and institutions. Its creation faced major constraints in some States because of the kind of earlier existing institutional arrangements for legal aid. We will see that this approach, besides highlighting the historical institutionalisms potential to analyze changes in Brazilian justice system, emphasizes the political activism of state actors as a key factor for the explanation. This kind of activism is essential to understand the development of Public Defenders Office in Brazil.