This article addresses the question of how public organizations with limited capacity manage to handle large scale crises. The case analyzed in this article is the sourcing of accommodation during the migration crisis in Sweden of 2015–2016. The event was a game-changer in Swedish migration policy following a more hesitant policy than before, even though new and substantial migration crisis have followed since then.

Results show how the legal framework for procurements was not adapted for extraordinary events. The Swedish state was forced to pay exaggerated prices as private contractors took advantage of the acute demand. The study develops our theoretical understanding of the sourcing process during crises and show how the short-term perspective and uncertainties that characterize crises encourage both suppliers and procurers of services to act opportunistically.

Background:

Knowledge of access to palliative care services, such as palliative care consultation teams, is crucial to identify areas of improvement for policy and practice. Research on general populations spanning all disease groups and multiple healthcare contexts is needed.

Objective:

The objective was to investigate the sociodemographic, disease- and care-related, and care structure-related factors associated with palliative care consultations for adult patients in the last week of life.Design:Cross-sectional, general population-level study based on linked Swedish national public authority registers and a national palliative care quality register.

Methods:

The study population included all adult patients deceased in Sweden between 2013 and 2019 and registered in the Swedish Register of Palliative Care, with an anticipated death, and not enrolled in specialised palliative care. Multivariable logistic regression analyses to investigate association with palliative care consultations.

Results:

In total, 8.2% of the 265,129 participants had received a palliative care consultation in the last week of life. The main multivariable analysis (Model 1) showed that those dying from neoplasms were more likely to receive a palliative care consultation (odds ratio (OR) 8.55, 95% CI 8.15–8.98) than those dying from circulatory diseases. Palliative care consultation was more likely with an increasing number of symptoms (OR 1.35, CI 1.32–1.37). Patients of old age and patients deceased in hospitals were less likely to receive a palliative care consultation. Moreover, factors such as educational attainment, healthcare region, living in a single-person household, and year of death were also associated with a palliative care consultation in the last week of life.

Conclusion:

Our findings show inequities in access to palliative care consultations in the last week of life. Considering changes to policy and clinical practice is motivated.

This article provides a systematic review of the literature on backsourcing. The aim is to synthesize existing literature in order to compare and analyze similarities and differences in backsourcing in the private and public sectors. The study asks questions about: which methods and theories have been used, why backsourcing has been implemented, and what reasons have been described for backsourcing. The study is based on an analysis of 500 articles about backsourcing and 33 articles in the final data set. The results show that backsourcing is primarily caused by: increased costs, lack of quality, and contract problems in the private sector, along with loss of control, cost saving, and changed strategy in the public sector. The study's synthesis highlights three explanations for how backsourcing is managed and interpreted in both the sectors. The article contributes specifically to summarizing current research on backsourcing, synthesizing how backsourcing has been studied, illustrating gaps in the research, as well as explaining relevant differences between private and public backsourcing. 

This study aimed to evaluate the development of healthcare teamwork during and after the collaboration tabletop exercises, through observation and interview methods. Integration and maturity theoretical models were employed to explain the collaborative challenges in teams that may suffer from unequally distributed power, hierarchies, and fragmentation. Using three-level collaboration tabletop exercises and the Command and control, Safety, Communication, Assessment, Treatment, Triage, Transport (CSCATTT) instrument, 100 healthcare workers were observed during each step in the implementation of the CSCATTT instrument using two simulated scenarios. The results show a lack of integration and team maturity among participants in the first scenario, leading to the delayed start of the activity, task distribution, and decision making. These shortcomings were improved in the second scenario. In-depth interviews with 20 participants in the second phase of the study revealed improved knowledge and practical skills, self-confidence, and ability in team building within trans-professional groups in the second scenario, which in concordance with the integration theory, was due to the attempts made in the first scenario. Additionally, there was an improvement in the team’s maturity, which in concordance with the maturity theory, was due to the knowledge and practical skills during scenario plays. These results indicate the importance of continuous tabletop training, and the use of CSCATTT as a collaborative instrument, to promote the development of collaboration and to test the concept of preparedness.

Bokinfo: 

Människobehandlande organisationer är en antologi som ger en bred överblick över välfärdens kärnverksamheter, vården, skolan och omsorgen, och beskriver vad som utmärker och skiljer dessa verksamheter från privata företag och organisationer när det gäller uppdrag, organisation, ledarskap och förändringsarbete.

I den första utgåvan från 2015 var utgångspunkten de förändringar som globaliseringen, teknikutvecklingen och marknadiseringen i form av New Public Management (NPM) medfört för de människobehandlande organisationerna. I denna andra utgåva har författarna, förutom att uppdatera och förnya innehållet utifrån aktuell forskning, även tagit hänsyn till andra betydande händelser i omvärlden, som flyktingkrisen i mitten av 2010-talet och coronapandemin. Dessutom har de följt upp det ökande intresset för granskning och kontroll och den växande kritiken mot NPM. Är alternativet en mer tillitsbaserad ledning och styrning inom välfärdssektorn?

Sex nya kapitel har tillkommit. De tar upp kunskapsbildning och forskning om människobehandlande organisationer, migration och flyktingmottagande, hur man hanterar hög belastning inom grässrotsbyråkratier, standardisering och horisontell kunskapsstyrning, chefers roll och vardag inom socialtjänsten samt tillsyn inom social barnavård.

Människobehandlande organisationer vänder sig till studerande på socionom-, läkar-, vård- och lärarutbildningar liksom studerande inom ekonomi, statsvetenskap, psykologi, sociologi och offentlig förvaltning. Den är även avsedd för praktiskt verksamma i människobehandlande organisationer.

Bokens redaktörer Staffan Johansson, Peter Dellgran och Staffan Höjer är professorer i socialt arbete vid Göteborgs universitet. Övriga författare är forskare inom socialt arbete eller angränsande områden vid ett flertal svenska universitet.

Local governments are bringing previously outsourced services back in‐house. Research into explanations for sourcing decisions in the public sector is growing, however, few researchers have investigated drivers of both outsourcing and backsourcing in local public‐governance organizations. In this study we utilize transaction cost economic theory (TCE) and political ideology to investigate underlying motives of sourcing in local public governance organizations. Based on a 2018 survey of chief financial officers (CEO) in all of Sweden's 290 municipalities, this study shows that backsourcing is strongly associated with outsourcing and that outsourcing and backsourcing should not be understood as opposite phenomena, rather as interdependent phenomena in a dynamic sourcing strategy. Outsourcing and backsourcing are driven in part by different factors: Outsourcing by political ambitions and economic factors relating to TCE, while managerial and pragmatic concerns are foregrounded for backsourcing.

The aim of this study is to understand and explain how street-level bureaucrats manage high workloads in public healthcare organisations. Data was collected through observations, interviews and documents. The results show that high workloads are reduced through use of collegial mechanisms at the organisation level. The study shows that workloads are reduced in a two-step process, the first is a negotiation between professionals and the second in the meeting with patients. The two-step process explains the limitation problems in more detail and makes an important contribution by explaining how high workloads are reduced in public health services.

The aim of this study is to contribute to the literature on how involuntary backsourcing in public organizations is performed in practice and how it affects the relationship between principal and agent.

The study focuses on two questions: (1) Which stages characterize the process when public contracts are involuntary terminated? (2) How does involuntary backsourcing affect the relationship between principal and agent during the transfer period? The study’s case concerns public backsourcing in Sweden, in particular, how a metropolitan municipality manages involuntary backsourcing.

This study provides in-depth insights into backsourcing and its practice, as well as the degree to which the conflict dimension between the parties is affected. The study shows-paradoxically-that the relationship between principal and agent during the transition phase is characterized by dependence, mutual exchange of information, collaboration, and less conflict. The study contributes to developing the theory of backsourcing, particularly the behavior that is played out between principal and agent in the transition stage.

The findings identify the need for public organizations which make outsourcing decisions to have contingency plans for bringing operations back in-house.