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Tending to innovate in Swedish primary health care: a qualitative study

Journal article
Authors G. Avby
S. Kjellstrom
Monica Andersson Bäck
Published in BMC Health Services Research
Volume 19
ISSN 1472-6963
Publication year 2019
Published at Department of Social Work
Language en
Keywords Primary care, Health care reform, Practice features, Innovation, Leadership, Culture and climate for, performance, management, organizations, diffusion, choice, system, reform
Subject categories Health Care Service and Management, Health Policy and Services and Health Economy


BackgroundPolicymakers in many countries are involved in system reforms that aim to strengthen the primary care sector. Sweden is no exception. Evidence suggests that targeted financial micro-incentives can stimulate change in certain areas of care, but they do not result in more radical change, such as innovation. The study was performed in relation to the introduction of a national health care reform, and conducted in Jonkoping County Council, as the region's handling of health care reforms has attracted significant national and international interest. This study employed success case method to explore what enables primary care innovations.MethodsFive Primary Health Care Centres (PHCCs) were purposively selected to ensure inclusion of a variety of aspects, such as size, location, ownership and regional success criteria. 48 in-depth interviews with managers and staff at the recruited PHCCs were analysed using content analyses. The COREQ checklist for qualitative studies was used to assure quality standards.ResultsThis study identified three types of innovations, which break with previous ways of organizing work at these PHCCs: (1) service innovation; (2) process innovation; and (3) organizational innovation. A learning-oriented culture and climate, comprising entrepreneurial leadership, cross-boundary collaboration, visible and understandable performance measurements and ability to adapt to external pressure were shown to be advantageous for innovativeness.ConclusionsThis qualitative study highlights critical features in practice that support primary care innovation. Managers need to consistently transform and integrate a policy push with professionals' understanding and values to better support primary care innovation. Ultimately, the key to innovation is the professionals' engagement in the work, that is, their willingness, capability and opportunity to innovate.

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