Consequences of monitoring and inspection systems in elder care – steering, accountability and organizational change
This research project studies how the National Board of Health and Welfare’s system for inspection of eldercare and the Swedish Association of Local Authorities and Regions' Open Comparison, a softer evaluation system, function in the eldercare sector in Sweden.
Enhanced national inspections and new benchmarking systems such as Open Comparisons (OC) are expected to ensure a well-functioning eldercare. However, there is a lack of studies of consequences of evaluation systems for eldercare practice. This research project examines how the National Board of Health and Welfare’s system for inspection of eldercare, a hard form of evaluation, and OC, a softer form of evaluation, function in the eldercare sector in Sweden. Three research questions are explored: 1) How do the evaluation systems work one by one and together in terms of governance, accountability and organizational change? Do the systems work as intended or in other ways? 2) How do key actors perceive the systems as regard relevance, reliability and representation of services, and how have the reviewed actors responded to the evaluations? 3) What are the implications of the systems for the content of eldercare, routines, knowledge use, etc.? The research project is designed as a two-part study. Study 1 compares the OC and inspection system in four municipalities which have been selected based on size, ranking results, and service providers. This case study investigates the effects and consequences of both systems and their products at the national, municipal and organizational level, as well as how the systems interplay. Study 2 explores effects and consequences of the national inspection system for policy and practice, mainly among local politicians and service providers in a sample of municipalities. The two studies involve document analysis, surveys, and interviews with politicians, managers, staff, users and inspectors. The project is aimed to contribute with new knowledge of how evaluation systems are used and function in terms of governance, accountability, and organizational change, and how local policymakers, professionals and clients are affected by different kinds of evaluation and evaluation systems.