Inga-Lill Johansson

Person-Centered Care — Ready for Prime Time

Long-term diseases are today the leading cause of mortality worldwide and are estimated to be the leading cause of disability by 2020. Person-centered care (PCC) has been shown to advance concordance between care provider and patient on treatment plans, improve health outcomes and increase patient satisfaction. Yet, despite these and other documented benefits, there are a variety of significant challenges to putting PCC into clinical practice. Although care providers today broadly acknowledge PCC to be an important part of care, in our experience we must establish routines that initiate, integrate, and safeguard PCC in daily clinical practice to ensure that PCC is systematically and consistently practiced, i.e. not just when we feel we have time for it. In this paper, we propose a few simple routines to facilitate and safeguard the transition to PCC. We believe that if conscientiously and systematically applied, they will help to make PCC the focus and mainstay of care in long-term illness.

Accounting for trust: some empirical evidence

This paper is based on case studies of performance-evaluation routines in two small companies in Sweden - one firm of consultants and one manufacturing company. In the firm of consultants the research was organised as a longitudinal case study. The empirical material was collected over a period of four years and consisted of different types - interviews, video recordings, field observations and sociograms. The research at the manufacturing company was organised as an action research study. One of the authors remained with the company for over a year, observing and participating in real-life situations. In line with Old Institutional Economics institutions are seen as the social linkage of human activities created and recreated by habitual thoughts and actions. Unlike earlier studies that see performance evaluation as a tool for ensuring improvements in organisational performance, our cased reveal no such clear relationship. By focusing on the accountants part in the action-reaction chain between evaluator and evaluated, it is possible to unveil evidence that performance evaluation is dependent on trust, as too are the production and reproduction of performance-evaluation routines.

Responsibility in action: expressions of values in a Swedish company

Purpose – To illustrate and discuss how different types of responsibility values are mobilised in a Swedish international company. Design/methodology/approach – The paper is informed by a constructivist pragmatism framework. The part of the study related to the case site was inspired by an ethnographic research approach and involved intensive face-to-face observations over a period of two years. Data was collected at four main levels: external and internal documents, observation of project meetings, interviews with project members, and informal talks with organisation members. Findings – Possible conflicts of interest between human and business perspectives are exposed. Awareness of these interest-conflicts, however, facilitates a potential bridging of the two perspectives. Our findings suggest possible explanations as to why management control (MC) models work in practice. Although values pertaining to shareholder maximisation are given prominence in external communication, the internal MC model also emphasises the values considered necessary and desirable by professionals, such as confidence, commitment and respect. The study reveals that the way values are handled affects the responsibility taken by employees in everyday situations. By using the constructivist pragmatism framework, it becomes clear that values cause people to act, and not MC systems. Originality/value – Although many studies have described the shortcoming of MC models, few studies platform from the concept of responsibility. In this paper it is shown how accounting communicates values underpinning responsibility, and contributes towards explaining why certain types of MC models can be more successful than others.

On the Need for an Ethical Understanding of Health-Care Accountability

Abstract In Sweden, as in many other Western countries, public health care is challenged by increasing demands for care and continuing budget deficits. Person-centred care (PCC) has been introduced as a new strategy to ameliorate the perceived fragmentation in care and is expected to decrease treatment time, reduce the need for return visits, as well as increase patient satisfaction. However, the changing clinical practices necessary for the PCC approach are assumed to require new accountability practices. This article is primarily an attempt to provide a conceptual analysis of ethical accountability, i.e. a type of accountability that takes into account the human relational responsibility, partial incoherence, and power of reflection. On the grounds of this characterisation, the article aims to provide a basis, among other things, for a discussion of the possibilities of identifying and empirically studying the multimodal expressions in communication that are relevant for this type of accountability. After an initial discussion of the debate on the limits of viewing accountability as transparency, we then turn to our methodological approach and introduce a conceptual analysis of accountability. Next, we discuss some additional features of accountability. Finally, we discuss the possibilities of empirically studying the institutionalisation of ethically informed accountability within person-centred health care.

Trusting and distrusting in dialogue: A study of authentic medical consultations

The purpose of this chapter is to contribute to the understanding of trusting as a dynamic relational process that can vary with circumstances. Based on an analysis of a number of physician–patient consultations in a Swedish hospital, we show how consultations lead to increased trust or decreased trust and in some situations have no apparent effect. The consultations, and the accounts given in them, can lead to trusting if they correspond to the uncertainty or needs that the other party expresses, assuming willingness to collaborate and cooperate. However, counteracting distrust (perhaps using accounts) is complicated, especially when this unexpectedly becomes necessary in ongoing interaction.