PHR in health and social care for older people – regional development through learning within and across organisations

Abstract

The study draws on findings from a series of seven participatory action research projects in community care for older people carried out over a period of eight years in 20 municipalities in southern Sweden. The analysis here looks at social impact across administrative levels and geographical scales. Different professional groups and care workers in community care participated, crossing divides between social work and health care. The participatory methods all involved a phase of individual reflection, a phase of reflection in practice with colleagues and mixed groups at the regional level, including unit managers and directors in some stages. Impacts concerned interprofessional learning and improved conditions for collaboration in care for older people across institutional boundaries as well as organisational learning across the municipalities. The action research approach was characterised by intensive work with values, empowering low-status professional groups. Social impacts were achieved beyond each project by benefitting from the multi-stakeholder design, using the structure of the organisations and the regional R&D department of the Association of Local Authorities. Over time, the different projects thus contributed to regional development ‘from below’. Nevertheless, employer perspectives tended to determine which conclusions from the projects were eventually implemented and prioritised. Continued reflective dialogue meetings between professional groups are therefore, needed as part of regular work processes. Local and regional structures need forms of autonomy that allow them to implement recommendations from participatory projects. Finally, employee perspectives need to be reflected in decision-making at all levels, particularly including low-status groups of care staff.

Keywords:

• Participatory health research
• community care
• organisational learning
• empowerment
• values

Disclosure statement

No potential conflict of interest was reported by the authors.

Funding

This work was supported by the Scania’s Municipalities, Region of Scania, Swedish National Board for Health, University of Kristianstad, University of Malmö (CTA).

Acknowledgement

Karen Lagercrantz R&D and Former Director Stig Ålund at Scania’s Association for Local Authorities who made the action research platform possible.

Notes

1. Community care in Sweden involves nursing home, homecare and social work. Social care and community care professionals are employed by local authorities in the municipalities, whereas staff at hospitals and in primary care are employed by the Region Skåne county council. Community nurses and enrolled nurses provide health care under the national law of health (Hälso- och Sjukvårdslagen), in a social care system in community care that is organised by the national social law for the people living in the municipalities (Socialtjänstlagen). The policies for health care in the communities are decided by medical expertise and stakeholders from Region Skåne.