The article draws on a three-year ethnographical study investigating how “service user involvement” was constructed (i.e. understood, implemented, and performed) within two large Swedish welfare organizations – a county-based psychiatric organization and a municipal social service administration (see Eriksson 2015). When analyzing the interactions between the user movement and the welfare organizations, a relationship much like cooptation (Selznick, 1949) was revealed. The article outlines four characteristic features of this coopting relationship: (1) The bonding between the parties, incorporating the user representatives in the organizations and their institutional logic; (2) The organizational framing of the user involvement activities; setting the initial rule for how to act/speak, where to act/speak, when to act/speak as well as what to speak about; (3) The organizational control exercised as the activities took place, directing the discussions and interaction to align with the interests of the welfare organizations; and (4) The resistance exercised by user representatives, enabling them to influence the organizations and contribute to change. Together, these four features disclose service user involvement as a “sanctioned resistance”: At the same time as the institutionalized service user involvement controls and constrains the way service user representatives act and pursue their goals, it gives them a possibility to challenge the welfare organizations from within. However, the influence that is permitted can be understood as adjustments within the prevailing institutional logic, rather than changes that transformed the organizations in more profound ways.
This paper was inspired by a peculiar theme that emerged from qualitative interviews in Iceland, Norway and Sweden with leaders of Centres for Independent Living (CILs). CILs are peer-led organisations that maximise user-control of disability services. Paradoxically, the Nordic reputation as forerunners in deinstitutionalisation and independent living was considered an impediment to implementing Article 19 of the UN Convention on the Rights of Persons with Disabilities which requires “access to a range of support services, including personal assistance necessary to support living and inclusion in the community”. This contradiction prompted the questions: How is Article 19 implemented in Nordic welfare services? And why is previous progress towards independent living and personal assistance seen as an impediment to implementing the rights-based approach required by the Convention? The findings suggest that it is difficult to change a developed welfare system in which there are vested interests in maintaining the status quo. The reputation of “being number one” conceals problems such as inflexible services and the imbalance of power where the control of services lies with the system and the professionals, not the users.
Despite the avowed aims of the Icelandic legislation to provide family-centred and inclusive services, families raising disabled children commonly express their experiences of fragmented services provided more on the terms of the service providers than the users. This article is based on data derived from an on-going qualitative multi case-research in three municipalities in Iceland. The aims of the paper are 1) to identify the main contradictions that explain tensions and dilemmas within the service system as experienced by the parents, and 2) to suggest potential solutions for improving practices in accordance with family-centred inclusive policy and enhanced user participation. The cultural-historical activity theory was applied as an analytical framework. Three activities central to the wellbeing of the children and their families were identified as the unit of analysis, and contradictions within the activities were located and classified by following the expansive learning theory. Based on our findings we propose Edwards’s three ‘gardening tools’ of relational practices as innovative and appropriate concepts for the necessary changes needed. By utilising these tools, the disabled children and their families are brought to the forefront and the professionals enhance their expertise in partnership with all stakeholders.
Brugerinddragelse er i stigende grad omdrejningspunktet i bestræbelser på at reformere sundhedsvæsenet i de nordiske lande og må forventes potentielt at forandre autoritets- og videnshierarkier i omsorgsarbejdet. Brugerinvolvering er imidlertid et bredt begreb og kan bygge såvel på ideer om demokratisering som effektivisering via redistribution af opgaver og ansvarliggørelse af brugerne. I denne artikel udforsker vi, hvordan brugerinvolvering praktiseres på to store kronikerområder, psykiatri og kronisk obstruktiv lungesygdom (KOL), der repræsenterer meget forskellige ideer om brugerinvolvering. Psykiatrien er præget af stærke brugerbevægelser med fokus på demokratisering, mens KOL-området snarere er præget af en effektiviserings- og ansvarliggørelseslogik. Artiklen er baseret på eksplorative feltstudier på de to områder gennemført som led i et større projekt om brugerinddragelse og har fokus på brugerinvolveringsmetoder, der bygger på samproduktion, og som på forskellig vis integrerer brugernes egen viden, vurdering og perspektiver. Artiklen viser, hvordan relationer mellem professionelle og brugere transformeres på forskellig vis på de to felter. Den peger desuden på, hvordan nye former for viden vinder indpas, men på måder, der rejser dilemmaer og modsætninger for de professionelle. Sluttelig diskuteres ansatser til nye rum, som på en anderledes måde er åbent for medbestemmelse og hverdagslivsperspektiver, men som også byder på udfordringer.
User involvement is increasingly the focus reforms of the health care system in the Nordic countries, and may be expected to change the authority and knowledge hierarchies in the care work. User involvement, however, is a broad concept and may be based on ideas of democratization as well as efficiency, redistribution of tasks and user accountability. In this article, we explore how user involvement is practiced in two major areas, psychiatry and COPD, where very different ideas of user involvement are prevalent. Psychiatry is characterized by strong user movements aiming at democratization, while, in the field of COPD, logics of efficiency and accountability are dominant. The article is based on exploratory field studies carried out as part of a larger research project, focusing on methods based on co-production and integrating the users' own knowledge, assessment and perspectives. The article shows how relationships between professionals and users are transformed. It also underline how new forms of knowledge gain momentum, but in ways that raise dilemmas and challenges to the professionals. Finally, we discuss potentials for new spaces for care to emerge, spaces which in a different way are open to participation and everyday life perspectives, but also offer challenges.
Models or measures to strengthen the position of service users not only change the position of the users, they also alter the position of the professionals involved. However, different forms of involvement alter the position of professionals differently. The aim of this article is to present an analytical framework that allows for an examination of different, ideal types of involvement, and their implications for the positioning of professionals. Three basic forms of involvement are identified: involvement as a) self-determination and self-management, b) sharing of lived experience, and c) co-management and mediation of causes and concerns. Within each of these basic forms, different models or measures are classified according to the positions of patients and professionals respectively. The framework shows that professionals are repositioned as facilitators, not only therapists; as partners and co-workers, rather than sole experts; as learners, rather than experts and teachers; and as recipients rather than in the position of offering knowledge and skills. While detailed and long-term investigation is necessary to determine the impact of involvement in actual cases, the presence of models and measures to strengthen the position of the users in various ways transforms the context of professional work, as well as the classic meaning of professionalism.
Nordisk välfärdsforskning | Nordic Welfare Research ble etablert i 2016 og publiserer artikler innen et bredt spekter av velferdspolitiske temaer om de nordiske velferdssamfunn, som levekår og livssituasjon i befolkningen, arbeidsliv og arbeidsinkludering, sosiale tjenester, omsorg, folkehelse, funksjonshemming og alkohol- og narkotikapolitikk.
Tidsskriftet utgis to ganger i året og inneholder fagfellevurderte artikler på dansk, engelsk, norsk og svensk. Språkene er likestilt.
Tidsskriftet har som mål å være et flerfaglig, vitenskapelig tidsskrift. Det publiserer forskningsbaserte artikler som bygger på empirisk og/eller teoretiske analyser av høy faglig kvalitet. Tidsskriftets målgrupper er forskere og akademikere, studenter, politiske og administrative beslutningstakere, profesjonsutøvere, interesseorganisasjoner, media og en bred allmennhet.
Sven Bremberg, Karolinska Institutet, Sverige
Trine Wulf-Andersen, Roskilde Universitet, Danmark
Snæfríður Þóra Egilson, Universitetet i Island, Island
Tom Kettunen, Nordic Studies on Alcohol and Drugs, Finland
John Eriksen, Nordlandsforskning, Norge
Design: Type-it AS, Trondheim
Sats: Laboremus Sandefjord AS
Omslagsdesign: KORD / Sissel Tjernstad
ISSN online: 2464-4161
Tidsskriftet utgis av Universitetsforlaget AS (Scandinavian University Press) på vegne av Nordens välfärdscenter.
© Universitetsforlaget 2018 / Scandinavian University Press.