Collaboration in Health and Social Care : Service User Participation and Teamwork in Interprofessional Clinical Microsystems

Sammanfattning: This thesis addresses the relationship between citizens and the welfare state with a focus on the collaboration between service users and professionals in Swedish health and social care services. The overall aim of the thesis was to explore how professionals and service users experience collaboration in health and social care. Descriptive and interpretative study designs were employed in the four studies that comprise this thesis. A total of 87 persons participated in the four studies, including 22 service users and 65 front-line professionals. The research methods included focused group interviews, individual interviews and interactive participant reflection dialogues. The first study describes the discursive patterns in the front-line professionals’ constructions of ‘we the team’ which positions the service user as both a member and a non-member of the interprofessional team. The second study surfaces the difficulties of interprofessional teamwork as perceived by professionals. The third and the fourth studies explore how service users and professionals construct and perceive the concept of service user participation. The findings show that collaboration in terms of service user participation cannot only be understood as contract relationships between consumers and service providers. Service users and professionals perceive that there are several other ways to act as a citizen and for people to exercise human agency in relation to the welfare state. This thesis shows that the various conceptions of service user participation in interprofessional practice encompass dimensions that include themes of togetherness, understanding and interaction within the clinical microsystem. The findings of the four studies are discussed and used to create models that aim to conceptualise collaboration. These models can contribute to learning and improvement processes which facilitate the development of innovative service user-centered clinical microsystems in health and social care.