title: Goal orientation and conflicts: Motors of change in development projects in health care service.
abstract: In this article we present parts of a larger research study, which aims at explaining how a process-oriented innovation unfolds and develops over time in Swedish health care. Through a longitudinal field study of a national and a local development project, we analyze how the flow model--a process-oriented innovation that emphasizes the sequence of activities a patient undertakes through the health care system--has been developed in Swedish health care. We propose to explain how the development projects unfold over time through the use of process theories of organizational development and change. The national project is best understood as a process of evolution from the phase of selection of projects and teleological (goal-oriented, socially constructed development) and dialectic theory (development via conflict of 2 opposing ideas from different organizational entities) through the process in which national ideas face real-world practice. We also propose a synthesis of dialectics and teleological motors for explaining local development. This synthesis proposes that local development teams have a rather broad notion of what it takes to implement the flow model. The team knows the goal, procedures, and activities from a broad perspective. Through a search-and-interact process, in which other organizational entities such as IT consultants, medical units and politicians have a heavy influence, the group sets and implements goals. Details of how to proceed are, however, constructed in the process of acting. This occurs as ideas are developed and tested in real settings. We conclude the article by presenting managerial implications for understanding these process patterns.
authors.affiliation: Division of Quality Technology and Management, Linköping Institute of Technology, Sweden. matel@ikp.liu.se
authors.forename: Mattias
authors.initials: M
authors.lastname: Elg
authors.forename: Beata
authors.initials: B
authors.lastname: Kollberg
authors.forename: Jan
authors.initials: J
authors.lastname: Lindmark
authors.forename: Jesper
authors.initials: J
authors.lastname: Olsson
mesh_terms: D003695:Delivery of Health Care; D006801:Humans; D009937:Organizational Objectives; D016730:Program Development / Q000379:methods*; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D013222:State Medicine; D013548:Sweden