Mot nätverkssjukvård i komplex miljö - behov av en vetenskaplig syn på ledning för säker vård och effektiv resursanvändning

Sammanfattning: Since 2008 advanced home healthcare agencies (ASiH) in a larger Swedish county council has underwent a transformation, to become part of a coming concept: networked healthcare (NVS). NVS means that intermediate multi-organizational healthcare (IMV) will be produced often in the home, and from 2013 to an increasing number of patients in different age groups with different diagnoses and medical conditions - in large variability of needs. At the same time IMV has proved to be not simply practical to implement in a resource-efficient and patientsafe way. Based on theories from Command and Control Science the safetyproblem that arise in connection with IMV is a sign of the less known increasing need of the direction and coordination support that IMV requires.With a casestudy based research approach with interactive elements, different qualitative methods has been used in two phases between 2008 - 2013. The first phase is characterized by a phenomenological approach, while the second phase has a critical hermeneutic approach. Research methods includes fieldvisits with informal discussions, in-depth interviews, validation with respondents and two different methodologies for textanalysis.The main result shows that practical aggravating circumstances for safe care consists of lesser known and from 2013 increasing problems with direction and coordination, through expanded advanced IMV in the home as a part of NVS concept. This also as a result of inadequate and inappropriate direction and coordination support for IMV.The thesis concludes that the NVS represents a resource intensive health care concept, which requires a new view on the management issue and a network-related methodology for direction and coordination. This is to promote ethical, equitable, patientsafe and dignified advanced IMV so an optimized use of resources can be implemented, through shared responsibility and coordination in patientuniquely designed networkconstellations as a given work model.