Coordinated care for mental illness : A neo-institutional study of the ambition to coordinate care within a standardised care pathway for Schizophrenia

Standardised care pathways has been identified as an emerging trend in Swedish healthcare. After the policy’s success in cancer care Swedish policy makers have decided that the policy is to be implemented in other areas of the Swedish health care system as well. This process has resulted in the development of a standardised care pathway for the early stages of schizophrenia and similar conditions. To understand the effects of exporting the policy form one area of healthcare to another this thesis sets out to investigate how the policy might impact different agencies involved in the care and treatment of schizophrenia. The study focuses on the policy’s ambition to improve coordinated care interventions. Furthermore, this is done by exploring the agencies perception of coordinated care and the organisational changes the policy might entail. The thesis draws on neo-institutional theory and the translation process to explain the spread of ideas between institutions as part of the policy process. Data has been gathered by conducting semi-structured interviews with representatives from primary healthcare, specialized psychiatric healthcare and municipal care in two different regions. The regions has been selected by population and fiscal assets to generate two cases with large differences in resources to investigate the possible impact of resources on coordinated care and the perception of the standardised care pathway. The analysis shows resources, especially in the form of competence within the workforce, as well as the structure of guidelines and agreements as central themes with an impact on coordinated care interventions. Both limited experience and continuity within the work force as well as unclear guidelines emerge as processes that limit the ability to coordinate care. In line with the theoretical framework these are identified as processes that effect the uniformity of the rationalities within and between the affected agencies. Therefore, how well the policy handles these processes is identified as a central factor for its impact on the agencies involved