<p><b>The patient Botvid´s way to right care. The planning process of an inter-organizational care pathway project.</b></p><p>A general problem in an elderly patient’s care – and rehabilitation process, which involves different care providers, is that there is no one single staff that is responsible for the whole “production process” i.e. from diagnosis to completed treatment. All too often care providers focus on their own part of the process with insufficient communication with other providers, resulting in low quality of care. Poor co-operation also leads to increased demand for check-ups, unproductive waiting time, duplication of work and other inefficiencies. A solution to these co-ordination problems can be to introduce process orientation (integrated care pathways). A process view requires the concerned staff to look at their own work with other eyes. The process view implies that they need to change focus to what is best from the patient’s point of view.</p><p>Experiences from earlier reforms, that were centrally initiated and managed, show that the concerned staff (doctors, nurses etc.) had too little influence during the planning and implementation phases. Several official reports therefore call attention to the need for broad participation from all of the different staff categories in organizational development.</p><p>In this thesis a qualitative case study of the planning process of an inter-organizational project between primary care, hospital treatment and municipality care is presented. The aim of the project was to develop an organization that could support a process view among the care providers. The focus of the thesis is on how the project management acted to shape the necessary conditions for a process view to enable the professional staff to participate, and on the role that the change strategy played in this connection.</p><p>The results show that the professional staff had an active role in the management of the project. The initiator was a doctor, who managed the project team of 50 care staff together with a project leader. This team had a series of meetings and conferences during ten months. By exchanging ideas and experiences they found solutions to the operative problems that were the starting points for the project. They developed an action plan in consensus, with prioritized activities, which is now to be implemented.</p>

<b>The patient Botvid´s way to right care. The planning process of an inter-organizational care pathway project.</b> A general problem in an elderly patient’s care – and rehabilitation process, which involves different care providers, is that there is no one single staff that is responsible for the whole “production process” i.e. from diagnosis to completed treatment. All too often care providers focus on their own part of the process with insufficient communication with other providers, resulting in low quality of care. Poor co-operation also leads to increased demand for check-ups, unproductive waiting time, duplication of work and other inefficiencies. A solution to these co-ordination problems can be to introduce process orientation (integrated care pathways). A process view requires the concerned staff to look at their own work with other eyes. The process view implies that they need to change focus to what is best from the patient’s point of view. Experiences from earlier reforms, that were centrally initiated and managed, show that the concerned staff (doctors, nurses etc.) had too little influence during the planning and implementation phases. Several official reports therefore call attention to the need for broad participation from all of the different staff categories in organizational development. In this thesis a qualitative case study of the planning process of an inter-organizational project between primary care, hospital treatment and municipality care is presented. The aim of the project was to develop an organization that could support a process view among the care providers. The focus of the thesis is on how the project management acted to shape the necessary conditions for a process view to enable the professional staff to participate, and on the role that the change strategy played in this connection. The results show that the professional staff had an active role in the management of the project. The initiator was a doctor, who managed the project team of 50 care staff together with a project leader. This team had a series of meetings and conferences during ten months. By exchanging ideas and experiences they found solutions to the operative problems that were the starting points for the project. They developed an action plan in consensus, with prioritized activities, which is now to be implemented.

This thesis follows a group of youths placed in secure unit care who have participated in a chain-of-care project aiming to better plan their discharge and aftercare. The overall aim of the thesis is to link a detailed description of these young people with an analysis of the project they participated in, and to undertake one- and two-year follow-up studies. Analytic focus is on the significance of gender, class and ethnicity. The study is mainly based on structured interviews performed at the secure units upon entry into care, discharge and at a one-year follow up. Data have also been used from criminal records and interviews with project staff. When entering care, these youths exhibited extensive problems in both family conditions and own behaviour. The major problem in boys was criminality while girls reported poor mental health. Professionals judge youth of foreign background as more criminal than youth of Swedish background despite a lack of difference in self-reported data. Some difference is also noticeable regarding class. Analysis of the project shows that out-of-home care was the most frequent intervention after leaving secure unit care, while other interventions were difficult to uphold over time. Few girls received help with their mental health problems. At the one-year follow up, the youths reported an overall better situation, although extensive problems still remained. Above all, girls’ mental health problems remained as before. At the 2-year follow up the study group was compared with a control group in order to investigate effects of the project regarding criminality and recommitment to secure unit care. The comparison shows that the project had no effect. This is discussed in relation to poor organization and the difficulty of adjusting a project like this to the target group, along with the substantial part played by gender, class and ethnicity in how the youth are construed and treated.