出版社：Utrecht University, Maastricht University, Groningen University
摘要：Introduction : Despite the current mantra that cross-sector teamwork and communication are the decisive factors in any attempt at creating an integrated and holistically oriented health service, the current institutional structures and conditions seem to actively stymie such cooperation. A high powered debate on the necessity of properly functioning cross-sector cooperation in the health service proceeds in its own isolated context and is also challenged at its very roots by the New Public Management (NPM) creed that has informed health service management in recent decades. The aim here is to investigate how tension and paradoxes in that cross-sector teamwork impact upon the ability of healthcare professionals across the relevant sectors to work together effectively towards the discharge of a patient. All this with a view to creating an integrated and holistic process for that patient. Theory and Methodology : The project draws partly on management theory vis-à-vis NPM and partly on Michel Foucault’s theory of governmentality. The data comes from a Danish Action Research project: Communication between health care professionals when elderly patients are discharged from hospital. The hands-on research project included 36 qualitative semi-structured interviews, fieldwork, workshops, picture and narrative analyses, interventions and evaluating sessions. Findings : Using two analysis samples from a completed action research project as a base line, I show how the tensions, dilemmas and paradoxes at play in cross-sector teamwork impact in a highly radical and thoroughgoing way upon the working conditions of healthcare professionals. They also impact upon their ability to implement cross-sector cooperation and at the same time create holistic healthcare procedures for patients and citizens NPM technologies and control mechanisms do not support attempts at cross-sector cooperation with a view to creating an integrated health service with a holistic ethos The patient discharge process is viewed as a battleground between healthcare professionals, where the ‘prize’ being fought for is the right to define the patient’s official designation within the health service. Cross-sector teamwork is viewed by the relevant players in the respective sectors as a source of annoyance and disruption Discussion : The analysis shows that, for cross-sector teamwork to truly work in the context of patient discharge, current structural conditions need to be challenged and rethought. It became clear, especially in our action research work how NPM-oriented control mechanisms lead to division, corporate target prioritisation and standardisation. All this makes it very difficult to achieve the teamwork necessary for an integrated and holistic approach to patient care that unites the various sector strands. It is ironic that there is a lot of talk and debate about an integrated and holistic patient-centred perspective, at the same time as the technologies, corporate targets and control mechanisms currently used in the healthcare system primarily support fragmentation and a bunker mentality. If the goal of an integrated and holistic health care service is to be properly put into practice, it is necessary to consider new ways of progressing and possible changes to the corporate structures and conditions under which healthcare professionals are working at the moment. Conclusion : This project can help attempts to create an integrated and holistic healthcare service, bearing in mind that it also carries a focus on the significance of (im)possible structural issues and conditions that, it is argued, impact upon cross-sector teamwork.
关键词：integrated care ; action research ; new public management ; cross-sector colaboration
