After a Decade of Action Research: Impactful Systems Improvement in Swedish Healthcare

This chapter illustrates the application over a decade of action research in the Swedish healthcare arena. Its focal question of how to deliver high quality, equitable and efficient care to an aging population – what is termed integrated care for the elderly – is one of the most central issues facing the future development of healthcare systems in all advanced economies. Countering early systems change approaches that entailed a rational, predetermined recipe for accomplishing change following a set of pre-planned steps that were implemented in a top-down fashion, an action research approach was adopted. This approach connects all stakeholders in complex care systems, inviting them to iteratively and jointly reflect on a desirable direction for the system and then subsequently act in that direction. AR practices also encourage reflections on the dynamic learning processes beneath the explicit patterns of an improvement effort, eventually contributing to the evolution of alternative plans for further action. The authors review the Action Research groundings and practices that have since inspired successful levels of integration. After presenting leveraging events in the developmental journey of integrated care, they conclude with key principles and practices pertaining to change processes in complex care systems