Organisation and management of Public Dentistry in Sweden : Past, present and future

Sammanfattning: Background Management and organisation of professional organisations is difficult with the tensions between the authority of the administration/management and the autonomy of the professionals. Overall objective The overall objective of this thesis was to contribute to a greater understanding of how professional organisations may be governed and man¬aged in a long-term efficient way, thus creating a healthy work place and an accountable organisation. The main interest lies in the analysis of the organisational factors that influence, positively or negatively, both the capabilities of the professionals to give good service as well ass the possibilities for the patient to co-operate in the production of the person¬alised service. The organisational and managerial factors can hinder or facili¬tate the care situation. They also set obstacles, or facilitate the governance of the organisation by input from the other factors besides organisational ones. Results Four papers are included in the thesis. The first paper sets out to define the professions in dentistry in Sweden. Dentists and, to a lesser degree from theories on professionals; dental hygienists were the identified professional groups. The second paper scrutinised the external environment for the dental professions in the form of political decisions, i.e. laws and regulations. The findings were that certain politically attractive ideas might reoccur at a later time despite good scientific arguments against them. One such idea was that the reimbursement from the National Dental Insurance or the fees in the Public Dental Health Service (PDHS) should be based on the patient’s income. Also indicated in this paper were ways of influence the political processes, by active participation in the early stages of decision-making The third paper dealt with the heads of the PDHS in the Counties and was a questionnaire to them on management. It was found that ideas on management and organisation usually were embedded in the way the respective county council was organised. A strong belief in advantages of scale was noted, both for administration and also for dental care itself. The fourth paper compared overall job satisfaction among publicly employed dentists in Denmark and Sweden. A focus on size of clinic, on professional development and on influence at the work place was found to be important. The Danish dentists were generally more satisfied with their overall job situations than the Swedish ones. One explanation might be found on the environment for the respective service with a much stronger element of competition in Sweden. Conclusions Professional organisations presents challenges in management compared to producing companies, as control of the work lies within the professional groups themselves. Management in he PDHS has an added difficulty in the two tiered political governance in Swedish public dentistry. National guidelines for good dentistry are presently introduced and whether that improves the situation for the management or not remains to be seen. The professions in Swedish dentistry might benefit from a clearer division of tasks where the public and the patients’ expectations from each category can get clearer. The observed trend towards larger units in the PDHS needs to be followed closely to ascertain dental services also in rural areas. Larger clinics demand a more professional view on management and more administrative control, which is in contradiction with the views on good work expressed by Swedish dentists. The balance between good work for dentists, an efficient organisation and perceived good service to the public will be an object for further studies.