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The local and the national in community care: exploring policy and politics in Finland and Britain
- Authors:
- BURAU Viola, KROGER Teppo
- Journal article citation:
- Social Policy and Administration, 38(7), December 2004, pp.775-792.
- Publisher:
- Wiley
International literature on community care tends to focus on the national level of welfare institutions and policies. However, community care is largely a locally tailored service and this paper makes a case for local comparisons of community care policies. Using local case studies from Finland and Britain, the paper argues that focusing on the local level contributes to the comparative study of community care in two ways. First, local comparisons highlight the often distinctively local nature of community care policies and thereby add to our understanding of community care. Second, local comparisons extend existing cross-country explanations of community care by showing that community care is largely shaped by local politics, together with indirect structuring by national contexts. As such, the local case studies highlight the importance of the relationship between policy and politics, which has often been neglected in comparative research.
Governing the coordination of care for older people: comparing care agreements in Denmark and Norway
- Authors:
- VABO Signy Irene, BURAU Viola
- Journal article citation:
- International Journal of Social Welfare, 28(1), 2019, pp.5-15.
- Publisher:
- Wiley
Increasing specialisation and demands to decrease the length of hospital stays have important consequences for the integration of specialised health and local care services. Based on case studies of care agreements in Denmark and Norway, this article compares subnational governance strategies for coordinating care services for older people discharged from hospitals. The question is how, and to what degree, national government regulations have an impact on local service coordination strategies. The analysis reveals that the numerous subnational procedures for coordination are somewhat more itemised in Denmark, and that regional variation in care agreements is greater in Norway. The identified differences can partly be accounted for by national differences in regulation, which is tighter in Denmark than in Norway. The study suggests that despite decentralisation of responsibility, subnational procedures to facilitate coordination are heavily influenced by national government policy. (Edited publisher abstract)
The contribution of professions to the governance of integrated care: towards a conceptual framework based on case studies from Denmark
- Authors:
- BURAU Viola, KUHLMANN Ellen, LEDDERER Loni
- Journal article citation:
- Journal of Health Services Research and Policy, 27(2), 2022, pp.106-113.
- Publisher:
- Sage
- Place of publication:
- London
Objective: Good governance of integrated care is key to better health care, but we know little about how professions can help make this happen. Our aim is to introduce a conceptual framework to analyse how professions contribute to the governance of integrated care, and to apply the framework to a secondary analysis of selected case studies from Denmark. Methods: We developed a framework, which identified the what, how and why of the contribution professions make to the governance of integrated care. We included five qualitative Danish studies, using coordination as an indicator of integrated care. We adopted a thematic approach in our analysis, combining deductive and inductive elements. Results: Health professions engage in highly diverse activities, which fall into closely connected clusters of more formal or more informal coordination. Professions apply many different adaptive mechanisms at different levels to fit coordination into local contexts. Professions are driven by interlocking rationales, where a common focus on patients connects organizational and professional concerns. Conclusions: Our analytical framework emerges as a useful tool for analysis. The contribution of professions to the governance of integrated care needs greater attention in health policy implementation as it can promote more effective governance of integrated care. (Edited publisher abstract)
Sustaining an intervention for physical health promotion in community mental health services: a multisite case study
- Authors:
- CARSTENSEN Kathrine, KOUSGAARD Marius Brostrom, BURAU Viola
- Journal article citation:
- Health and Social Care in the Community, 27(2), 2019, pp.502-515.
- Publisher:
- Wiley
There is a growing body of literature on sustainability, but its definition and the factors that affect it are not well understood. This paper focuses on the sustainment of health promotion interventions in community mental health organisations, where the institutional context has been found to play an important role. Normalisation Process Theory (NPT) was used to characterise the extent of sustainment of health promotion interventions and to identify important factors that influence it. The study builds on a previously reported qualitative multiple case design focusing on four Danish community mental health organisations. This study aimed to include cases (provider organisations) with varied political‐administrative contexts that were expected to impact sustainment. Data included 27 semistructured interviews with managers and frontline staff. The analysis adopted a thematic approach combining within‐case and cross‐case analysis. One important factor contributing to sustainment was the high degree of coherence generated during and after implementation. Perceptions of meaningfulness and formal tools for external accountability such as municipal activity plans also stimulated the cognitive participation of management and staff in sustaining the intervention. On the practical level of collective action, working with health promotion in a continuous way was particularly supported by two formal tools: internal health policies and municipal activity plans. Sustainment was further aided by reflexive monitoring based on ongoing informal assessments, supplemented by information required for status reports to the municipality on individual users and information from the annual individual user health checks. Future studies should adapt NPT to a broader range of cases to assess more thoroughly its contribution to the literature on sustainment. Future interventions need to pay closer attention to securing continuous and active local management support as well as to political‐administrative contexts as potential external drivers of sustainment. (Edited publisher abstract)
Governing home care: a cross-national comparison
- Authors:
- BURAU Viola, THEOBALD Hildegard, BLANK Robert H.
- Publisher:
- Edward Elgar
- Publication year:
- 2007
- Pagination:
- 224p., bibliog.
- Place of publication:
- Cheltenham
This book offers a comprehensive analysis of the principle issues surrounding the governance of home care. In this context home care is taken to mean any care and support offered to older people in their homes. The analysis maps out governing arrangements in relation to formal and informal care services, informal care, care workers and users of care across nine countries: Estonia; New Zealand; Italy; the United Kingdom; Sweden; Japan; Germany; the Netherlands; the United States. The authors explore the ways in which country specific contexts shape governing arrangements and bring together insights form social care and public policy literature.
Understanding professional projects in welfare service work: revival of old professionalism?
- Authors:
- HENRIKSSON Lea, WREDE Sirpa, VIOLA Burau
- Journal article citation:
- Gender, Work and Organization, 13(2), March 2006, pp.174-192.
- Publisher:
- Blackwell
The professional terms for occupations that provide welfare services are changing. The introduction of new public management in the Nordic countries since the 1990s is indicative of wider developments. The article explores professional projects in welfare service work from both conceptual and empirical perspectives. The aim is to produce a gender-sensitive analysis of the professional projects at the lower levels of the occupational hierarchies in health care. The first part reviews the literature conceptualizing the societal and institutional embeddedness of professional projects. The institutional matrix of welfare states emerges as a key context in shaping the welfare service work performed by women-dominated professional groups. The second part examines the case of Finland and suggests that recent reforms have created new inequalities in the system of professions, in which occupational groups in welfare service work are becoming marginalized. This signals a move away from 'democratic professionalism' towards a revival of 'old professionalism'.