Health-care processes - A Study of Medical Problem-solving in the Swedish Health-care Organisation

Sammanfattning: This study is about medical problem-solving within its organisational context, the Swedish health-care organisation. The main purpose is to demonstrate how different types of medical problem-solving are affected by the structure of the health-care organisation. This involves the construction of a typology of medical problem-solving processes, and it is argued that the main characteristics of these processes are that they vary according to differences in medical technology and differences in the obscurity of the perceived medical problem. From this, four main processes are defined and demonstrated through empirical examples of the handling of illnesses. Furthermore, relevant aspects of structure are defined, and applied to empirical material (from hospitals and health-care centres) as examples to demonstrate how the present structure, at different organisational levels, influences the different medical problem-solving processes at the "work-floor" level. The main result of this study is an illustration of how the different ways of organising at different levels work together to restrict the problem-solving processes and deprive them of suitable conditions. When different problem-solving processes take place in the same structural setting they disturb each other. Under norms of efficiency the processes therefore need e.g. to have different integrative mechanisms, different principles for grouping of activities, and to be evaluated according to different criteria.