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

• Published in: BMC health services research Vol. 19; no. 1; p. 42
• Main Authors: Avby, Gunilla, Kjellström, Sofia, Andersson Bäck, Monica
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 18.01.2019; BioMed Central; BMC
• Subjects: 21st century; Adult; Aged; Analysis; choice; County councils; Culture and climate for; Culture and climate for innovation; diffusion; Female; Health care policy; Health care reform; Health Care Reform - economics; Health Care Service and Management, Health Policy and Services and Health Economy; Health services; Humans; Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi; Innovation; Innovations; Interviews as Topic; Laws, regulations and rules; Leadership; Male; management; Middle Aged; National health insurance; Organizational change; Organizational Culture; Organizational Innovation; organizations; Patient satisfaction; Practice features; Primary care; Primary health care; Primary Health Care - organization & administration; Public sector; Qualitative Research; Quality; Quality management; reform; Reforms; Success; Sweden; system; Sweden; Finland; Leadership; Practice features; Innovation; Culture and climate for innovation; Primary care; Health care reform
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-019-3874-y

Policymakers 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 Jönköping 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. Five 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. This 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. This 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.