Research project Structures for governance, based on knowledge – knowledge governance - as a means for improving the conditions for health and social services to provide coherent, effective and knowledge-based care, is currently in focus in Sweden.
A number of decisions have been made at government level, responsibilities have been divided between authorities and organizations, and new forms of cooperation have been created for this purpose in recent years. T
Processes and structures as drivers for quality development has been subject for research for a long time. There is currently a growing interest regarding these issues within the field of quality in care and welfare. The need to elucidate these issues interdisciplinary is obvious but not easy, as research paradigms and methods tend to clash more often than they interact. Any contribution that highlights the interaction between what is sought to achieve and the conditions for how this can happen, has a spot on the international research arena.
Our study will contribute to the knowledge on intermediate functions, operating in a complex context of quality development efforts involving many levels of actors, where the conceptualization is complicated. Our research also exposes challenges and prerequisites related to being an intermediary or facilitator in a knowledge governance system.
Research describes an increasingly complex reality where new knowledge and growing opportunities for quality and safety in care and welfare entails increasing demands on managing the boundary between financial management and care, political decisions and care user benefit. The external as well as the internal pressure on action on quality and development issues in care and welfare increases. The pursuit of using the best possible scientific evidence and proven practice of care and welfare is as obvious as it is proved difficult to implement fully. Supporting sustainable development in such a demanding context poses major strategic demands, whether it is continuous improvement in daily work or major projects and interventions.
Applying a systems perspective on development and change in practice has proved difficult, not least because a system view implies taking into consideration people and their understanding, will and ability. Concepts such as Learning Organization and Organizational Learning are other areas that are important for creating the prerequisites for transferring knowledge to practice. So are the major and constantly relevant areas of implementation and innovation research.
The challenge of being a facilitating external support structure for system-wide development work is described by Höög (2014). Facilitation is a concept that originates from Latin's facile, and is often used in an individual perspective where individual change agents support development work and change processes. Others describe facilitation as a multi-faceted process where a group, team or function jointly has a supportive mission or role, parallel to other organizational assignments (Dogherty, et al., 2010; Dogherty, 2012). Facilitation can also be about building organizational capacity and structures for continuous development.
This research overview shows that many perspectives must be used in order to contribute to a better understanding of how continuous and sustainable development of care and welfare at local level can be supported. Multiple perspectives are also needed to better understand how everyday activities can benefit from the power and resources of national initiatives / policies using support structures as key links in the chain that goes reaches the care user.
By adopting a system perspective and collecting data for the chain's key intermediate level, we highlight the conditions and challenges for a coherent knowledge governance. Conducting research during an ongoing process increases the possibility to understand such processes and key mechanisms that are otherwise difficult to capture or reproduce.
Studiedesign och metod
We are planning a case study with multiple embedded units of analysis and with a mixed methods approach. Mixed methods research takes advantage of using multiple ways to explore a research question, and is considered appropriate because we want to develop a more comprehensive understanding of conditions and perceptions. Mainly qualitative but also some quantitative data will be collected. Qualitative data will be analyzed by pattern-matching techniques guided by different qualitative content analysis methods, and descriptive quantitative analyses will be executed, using SPSS.
The study has four interlinked phases:
Phase 1: Mapping and analysis of national level descriptions of expectations on RCSS as a key link in the knowledge governance chain
Phase 2: Mapping and analysis of RCSS's organizational and operational situation and representatives' views on RCSS's role in the knowledge governance chain
Phase 3: Mapping and analysis of employees' perception of RCSS’ role in the knowledge governance chain and current activities related to knowledge governance
Phase 4: In-depth study in four regions, concerning conditions, challenges and expectations of RCSS in the linking role between national and local levels in knowledge governance efforts.
The choice of design is done based on the question asked (e.g. Creswell, 2013). To study ongoing processes in their natural context, case design is a logical choice. Searching patterns in data can contribute to an increased understanding. Study design and data collection instruments takes into account that data collection itself can contribute to ongoing processes in the setting. The action research approach chosen includes continuous feedback loops, and an ongoing dialogue with actors involved in the study.
The study has a systems approach, involving integrated subsystems, such as national and regional functions, groups and organizations involved in knowledge governance initiatives concerning social services and neighbouring health care, i.e. national authorities and regional collaboration and support structures.
There are 21 regions in Sweden, all of which are expected to have a RCSS for knowledge development in social services. Each RCSS is supposed to be part of the RCSS network, organized by SALAR.
Phase 1 starts with a document study, where public, national documents (e.g. reports, evaluations, plans) relating to knowledge governance (KnG) and carrying a regional perspective, especially related to RCSS, are compiled and analyzed. The purpose is to map the national description of expectations on RCSS role in KnG. The document study is analyzed by summative content analysis. Phase 1 continues with ten interviews with key people in national networks, committees and groupings that are related to KnG and RCSS. The aim is to get a more in-depth knowledge of the national views. The selection of respondents is an appropriate selection. The interviews will be transcribed and the material will be compiled, processed and analyzed by summative content
Phase 2 includes interviews by telephone or Skype with one key person in each RCSS, to map basic information about how RCSS is organized and perceived prerequisites for RCSS concerning work related to KnG. An appropriate selection will be made, involving approximately 25 respondents. The interviews will be transcribed and the material compiled, processed and analyzed by framework analysis. Descriptive data will be compiled and analyzed, concerning organizational factors. Documents will be collected, such as annual reports and other relevant material. Based on the results of the framework analysis above, the documents will be compiled and analyzed using content analysis.
In Phase 3, a digital survey is sent to all employees and other functions close to RCSS in all regions. The survey aims to capture individuals' perception of RCSS role and strategies for KnG-related activities. At the same time, they will be asked to assess expectations and experiences regarding RCSS role and conditions, as well as current activities related to KnG. The survey will have both closed and open questions, and be compiled, processed and be analyzed using directed content analysis and a compilation of descriptive data of organizational factors will be conducted (e.g. setting, work force, profile).
In Phase 4 further interviews are taking place. An appropriate selection of four regions will be made, and in each region, qualitative research interviews will be conducted with approximately 5-10 representatives from RCSS workgroup and ca 3-5 from an RCSS steering group or similar. Qualitative interviews will also be conducted with 2-4 key functions with connection to KnG. These interviews will be analyzed with framework analysis and summative content analysis. The interviews aim to deepen the knowledge of how representatives from the regional perspective experience and reason about challenges and prerequisites for being a key link in the knowledge governance chain. Furthermore, an additional data collection of new documents from the four selected regions will be made, used for a documentary study. These will be analyzed by summative content analysis. The documents provide additional knowledge about RCSS and Phase 4 perspectives.
The selection of respondents is primarily purposive, that is, those who are best considered to be able to answer the question are asked for an interview. Thus, this is a convenience sample insofar that we chose those who would be representative for our research topic (Jacobsen, 2002). Through the project, the Swedish Research Council's ethical principles apply to the handling and use of collected material.
For qualitative research interviews, we mainly use semi-structured instruments. This means that the interview manual consists of a number of basic questions, with scope for follow-up questions (Kvale, 2014). The follow-up questions are also prepared and asked if they have not already been answered in the basic question. Particularly in retrospective interviews, it is important to be aware of the difficulty of respondents to remember and describe past phenomena, feelings and experiences, especially if these changes over time. It puts great demands on both manual and interviewer to capture processes and change over time Qualitative content analysis is an area with many orientations (e.g. Kohlbacher, 2006). Hsieh & Shannon (2005) describes three basic forms of content analysis; Conventional content analysis suitable for use when theory is missing or weak; Directed content analysis used to validate or develop concepts from existing theory or theoretical frameworks; Summative content analysis that focuses on the occurrence and understanding of different concepts. Essentially, the two later types of analysis will be used. We will also use Framework analysis. Descriptive, quantitative analysis will be based on questionnaire and document data. Using mixed methods is a way to improve validity and reliability.
The PI is responsible for collected data. The research group has full access to research data, and performs data processing, analysis and report writing. The material will be treated confidentially and no personal data will be found in collected material and reported in profit and loss accounts. When the interviews are transcribed, no names or other personal data will be present that can identify individual interviewees. The same applies to the survey and any comments submitted in the survey.
The project has three main constellations; The Research group, The project management team and The reference group.
We are a strong interdisciplinary research group and we bring together researchers from different departments in Umeå University, Luleå University of Technology and Karolinska Institute. The scientific disciplines represented are sociology, social work, epidemiology and public health, organizational psychology, and management. The project will be hosted by Epidemiology and Global Health, which is considered to be “a strong research environment”. The distribution of responsibilities and work for the research group is done to best utilize from skills and experiences and is presented in table 3 below.
The project management team is led by PI, who has the strategic, formal and practical responsibility for the project, and coordinates external contacts and the work of spreading the project's work and results. The composition of the reference group is under consideration and some contacts has already been taken, but this will not be finalized until the project has been cleared. The reference group will function as a ball board for the project management team and the research group. We set for representatives many organizational levels and settings.