Quality in the Danish health care sector – patient identity in transition?

Publication: Research - peer-reviewPaper without publisher/journal

Abstract

The Danish accreditation model, which was implemented in 2010 as a mandatory part of the 2002 national strategy for health care quality (National Board of Health 2002), is currently being phased out in response to a revised quality programme adopted in 2015 (Mainz, Kristensen and Bartels 2015; Ikas 2015; Ministry of Health 2015). The change implies a gradual transition from an evidence based activity model to a value based quality model centered on patient involvement (Mainz et al 2015; Porter 2010; Rostgaard 2015). As a parallel trend over the past 30 years, welfare state ideology seems to have come under rising pressure by economic rationales combined with ideas of lean management and New Public Management (Valgårda 2003; Niklassson 2006; Lassen, Ottesen and Strunck 2015). Seeing that shifting quality perceptions and a stronger focus on patient involvement invites questions about the role of the patient in the Danish welfare system, we ask: 1) how is patient identity construed in selected legislation, steering instruments and reports issued by the Danish Board of Health, and 2) how may variation in the construal of patient identity be indicative of discursive struggle at the level of national health care policy in Denmark? We discuss our findings in light of requirements set forth in the new health care quality model and discuss tensions and conflicting discourses in the health care system that may affect the Danish welfare model. Our theoretical point of departure is literature about transition in the Nordic welfare state (Jensen 2014; Valgårda 2003, Torfing et al 2012) and a recent study of the Danish Health Act (Lassen, Ottesen & Strunck 2015). Our analytical approach is discourse analysis (Willig 2006; Fairclough 2003). References: Fairclough, N. 2003. Analysing Discourse. London and New York: Routledge. Ikas (2015) DDKM for sygehuse. Available from http://www.ikas.dk/deltagere-i-ddkm/sygehus/ddkm-for-sygehuse/ (validated 9 January 2016) Jensen, C. 2011. Velfærdsstaten. En introduktion. København: Hans Reitzels forlag. Lassen, I., Ottesen, A. M., and Strunck, J. (2015). Identitetskonstruktioner af patienter. Academic Quarter, 12, 136-153. Mainz, J., Kristensen, S., Bartels, P. (2015). Quality improvement and accountability in the Danish health care system. International Journal for Quality in Health Care, 1-5. Ministry of Health (2015) Nationalt Kvalitetsprogram for Sundhedsområdet 2015–2018. Avaliable from http://www.sum.dk/Aktuelt/ Nyheder/Sygehusvaesen/2015/April/~/media/Filer%20-%20Publikationer_ i_pdf/2015/Nationalt-kvalitetsprogram-for-sundhedsomraadet/Nationalt% 20kvalitetsprogram%20for%20sundhedsomr%C3%A5det%20-%20april %202015.ashx (validated 9 January 2016) The National Council on Quality Improvement in Health Care (2002). National Strategy on Quality Improvement in Health Care. Common Goals and Action Plan 2002-2006. Copenhagen, Denmark: National Board of Health. Niklasson, G. (red.). 2006. Samfund og kultur i sundhedsarbejdet. København: Frydenlund. Olesen, F. 2010. ”Den forstærkede patient”. Thorgaard, K., Morten Nissen og Uffe Juul Jensen (red.). Viden, virkning og virke – forslag til forståelser i sundhedspraksis. Roskilde: Roskilde Universitetsforlag: 307 – 332. Porter, M. (2010). What Is Value in Health Care? The New England Journal of Medicine, 2477-2481. Rostgaard, T. (2015). Når fortiden er længere end fremtiden. Stockholm: Nordens Välfärdscenter. Available from www.nordicwelfare.org Torfing, J., Peters, B.G., Pierre, J. and Sørensen, E. 2012. Interactive Governance. Advancing the Paradigm. Oxford: Oxford University Press. Vallgårda, S. 2003. Folkesundhed som Politik. Danmark og Sverige fra 1930 til i dag. Aarhus: Aarhus Universitetsforlag. Willig, C. 2008. Introducing Qualitative Research in Psychology. New York: Open University Press.
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The Danish accreditation model, which was implemented in 2010 as a mandatory part of the 2002 national strategy for health care quality (National Board of Health 2002), is currently being phased out in response to a revised quality programme adopted in 2015 (Mainz, Kristensen and Bartels 2015; Ikas 2015; Ministry of Health 2015). The change implies a gradual transition from an evidence based activity model to a value based quality model centered on patient involvement (Mainz et al 2015; Porter 2010; Rostgaard 2015). As a parallel trend over the past 30 years, welfare state ideology seems to have come under rising pressure by economic rationales combined with ideas of lean management and New Public Management (Valgårda 2003; Niklassson 2006; Lassen, Ottesen and Strunck 2015). Seeing that shifting quality perceptions and a stronger focus on patient involvement invites questions about the role of the patient in the Danish welfare system, we ask: 1) how is patient identity construed in selected legislation, steering instruments and reports issued by the Danish Board of Health, and 2) how may variation in the construal of patient identity be indicative of discursive struggle at the level of national health care policy in Denmark? We discuss our findings in light of requirements set forth in the new health care quality model and discuss tensions and conflicting discourses in the health care system that may affect the Danish welfare model. Our theoretical point of departure is literature about transition in the Nordic welfare state (Jensen 2014; Valgårda 2003, Torfing et al 2012) and a recent study of the Danish Health Act (Lassen, Ottesen & Strunck 2015). Our analytical approach is discourse analysis (Willig 2006; Fairclough 2003). References: Fairclough, N. 2003. Analysing Discourse. London and New York: Routledge. Ikas (2015) DDKM for sygehuse. Available from http://www.ikas.dk/deltagere-i-ddkm/sygehus/ddkm-for-sygehuse/ (validated 9 January 2016) Jensen, C. 2011. Velfærdsstaten. En introduktion. København: Hans Reitzels forlag. Lassen, I., Ottesen, A. M., and Strunck, J. (2015). Identitetskonstruktioner af patienter. Academic Quarter, 12, 136-153. Mainz, J., Kristensen, S., Bartels, P. (2015). Quality improvement and accountability in the Danish health care system. International Journal for Quality in Health Care, 1-5. Ministry of Health (2015) Nationalt Kvalitetsprogram for Sundhedsområdet 2015–2018. Avaliable from http://www.sum.dk/Aktuelt/ Nyheder/Sygehusvaesen/2015/April/~/media/Filer%20-%20Publikationer_ i_pdf/2015/Nationalt-kvalitetsprogram-for-sundhedsomraadet/Nationalt% 20kvalitetsprogram%20for%20sundhedsomr%C3%A5det%20-%20april %202015.ashx (validated 9 January 2016) The National Council on Quality Improvement in Health Care (2002). National Strategy on Quality Improvement in Health Care. Common Goals and Action Plan 2002-2006. Copenhagen, Denmark: National Board of Health. Niklasson, G. (red.). 2006. Samfund og kultur i sundhedsarbejdet. København: Frydenlund. Olesen, F. 2010. ”Den forstærkede patient”. Thorgaard, K., Morten Nissen og Uffe Juul Jensen (red.). Viden, virkning og virke – forslag til forståelser i sundhedspraksis. Roskilde: Roskilde Universitetsforlag: 307 – 332. Porter, M. (2010). What Is Value in Health Care? The New England Journal of Medicine, 2477-2481. Rostgaard, T. (2015). Når fortiden er længere end fremtiden. Stockholm: Nordens Välfärdscenter. Available from www.nordicwelfare.org Torfing, J., Peters, B.G., Pierre, J. and Sørensen, E. 2012. Interactive Governance. Advancing the Paradigm. Oxford: Oxford University Press. Vallgårda, S. 2003. Folkesundhed som Politik. Danmark og Sverige fra 1930 til i dag. Aarhus: Aarhus Universitetsforlag. Willig, C. 2008. Introducing Qualitative Research in Psychology. New York: Open University Press.
Original languageEnglish
Publication date1 Mar 2017
StateAccepted/In press - 1 Mar 2017
Event - Aalborg, Denmark

Conference

Conference14th International and Interdisciplinary Conference on Communication, Medicine and Ethics
Number14
LocationAalborg University
CountryDenmark
CityAalborg
Period04/07/201606/07/2016

    Keywords

  • The Danish accreditation model, New Public Management , welfare state ideology , patient identity , discourses, the Nordic welfare state , the Danish welfare system
ID: 252135128