Organisation som mode : kontrasterande bilder av svensk hälso- och sjukvård

Sammanfattning: How come that Swedish health care has shown such a preference for organizational change in the 1970’s and 80’s? How come that reorganizations in health care are often characterized by campaigns and standardization, bringing but small effects on everyday life routines? What kinds of norms and values about human interaction are reflected in the organizational ideas that are most popular today?These questions are the starting point for this dissertation. The focus is on "organizational ideas", i.e. concepts of dividing, coordinating and managing work, beginning with a discussion of possibilities and problems of pluralism in organizational theory. Previous research has observed a kind of one-sidedness in thinking about organization dominated by the so called functionalist paradigm, a way of perceiving organization much like an objective phenomenon, which can be studied in ways similar to the natural sciences. In the dissertation an idea of Reflective Understanding of Organization is developed, taking into consideration a plurality of perspectives, interpretive as well as critical ones. Producing "Contrasting Images", i.e. interpretation of organizations from different perspectives, is seen as a strategy to enhance reflection.Three current organizational ideas in Swedish health care are analyzed: "The Basic Unit" (a concept describing the smallest independent administrative unit in the decentralized organization), "Business Planning" (a procedure for goal setting and strategy formation at the level of the Basic Unit), and "The Dala Model", a market oriented structure of health care organization. Each case study is treated in two ways; first through "Attentive Hermeneutic Reading", an effort to understand the idea from the perspective of the actors involved, and then "Producing Contrasting Images" to examine and reveal underlying perspectives.In the concluding discussion a view of health care organization as a phenomenon of fashion is presented, i.e. a process of diffusion and (re)interpretation intending to create order out of chaos through new combinations of "Archetypes of Organizing", deeply rooted conceptions of human orderliness. Organizational change can in this way be seen as a kind of "kaleidoscoping", i.e. rearranging a restricted amount of ideas in a way that is aligned to the spirit of the Time - The "Zeitgeist". This leads to waves of fashion, which have only minor effects on the micro-world of health care, e.g. the interaction between patient and doctor/nurse.As an alternative, the idea of "The Reflective Conversation of Everyday Life" is proposed as a metaphor for organizing. This concept - focusing on process rather than structure - is inspired of studies of how everyday organization of health care is created. This could lead to more pluralism instead of onesidedness. "Reflective Organizing" is used as a concept for such a procedure, which, among other things, uses contrasting images - produced by independent observers - as a part of the organizing process.