Spændingsfyldt top-down og bottom-up orienteret styring af tværsektorielle samarbejdsprocesser i det danske sundhedsvæsen

Abstract

This article is about the different meanings that improvement processes are given when health professionals try improving their cross-sectoral cooperation on the discharge of elderly patients. With examples from a completed PhD action research project, I focus at how differ- ent discourse’s powerful forms of knowledge influence the ways in which health profes- sionals can understand, talk and create space for improving their cross-sectoral cooperation practices.

Despite the fact that the Danish healthcare system in 2017 is characterized by a strong discourse about improving the health professionals’ practices, it seems almost impossible for health professionals working in direct contact with patients to contribute to the improvement work with their professional knowledge and experience. In particular, the focus of recent decades on improvement through the use of evidence-based knowledge, documentation, efficiency and standardization has forced the health professionals to contribute their specific professional knowledge in the work of improving practices.

The purpose of the article is to show the complexities and tensions dilemmas that affect the health professionals’ work on improve-

ment processes in a healthcare under pressure. Through the analysis, I show how ‘to improve’ is infiltrated by a top down management culture, where the incentive is streamlining, an increased flow of patients, and fast discharge – and the bottom up ideology’s idea that if only those who are close to the issue participate in the improvement work, so it will succeed. In conclusion, I reflect on the absurdity and obvious waste of resources that are associated with displacing the two management logs, and I argue that new and cross-sectoral cooperation and communication spaces must be created and explored.