Kvalitetsarbetet i Nacka : En fallstudie av kundvalsmodellen inom äldreomsorgen

Sammanfattning: This essay discusses the interaction between the authorities in Nacka municipality in Sweden and supervisors within the eldercare. In Nacka politicians have gradually started delegate responsibility for how care-giving for the elder should be done and focus instead on formulating economical objectives and overall rules. It is up to the approved supervisors of eldercare to deliver good care and quality. The method chosen to accomplish this is public choice. This method is a part of the big New Public Management (NPM) reform which have had a big impact on Swedish public sector since the 1980´s. The general idea of NPM is to govern institutions within public sector in a way that is more similar to the business worldwhere there is competition and control of costs and incomes. By doing this the politicians hope to make the public sector more efficient and less costly and at the same time give more power to the market (customer) in order to secure higher quality. In the public choice method every supervisors gets a certain amount of money for every patient, no matter if it is operated by a public or private supervisor. In turn, the customer (patient) have the possibility to choose and change organizer if they are not satisfied with the care they are receiving. Satisfaction is measured by sending out questionnaires to every customer to ensure quality and to control the supervisors. The NPM governing has changed the production of the public sector supervisors in several ways, increasing efficiency. Today there are small business units with detailed accounting and control of costs in every unit. A central theme in this thesis is how supervision of the eldercare is practised in Nacka and how the municipality formulates and communicates goals to secure quality. The study shows that the supervisors feel disengaged from the authority. They experience much freedom in their daily work and supervision is very rare. A conclusion is that NPM has not replaced the traditional ways of governing, such as bureaucracy and scientific management, but is rather a complement to those.