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På senare år har det tagits allt fler initiativ till att genomlysa sjukvården. Som exempel kan nämnas ackreditering, evidensbaserad medicin, WHO:s rankningar av olika länders sjukvårdssystem och mediernas jämförelser av olika sjukhus. Stora förhoppningar knyts till nya tekniska möjligheter att skapa öppenhet och utkräva ansvar.

Den här boken undersöker strävan efter transparens i svensk sjukvård. Hur väl går det egentligen att återge sjukvårdskvalitet med några få enkla mått? vad synliggörs och vad kommer i skymundan? Transparens i sjukvården är varken oproblematisk eller gratis, men kraven på insyn kommer inte att minska, snarare tvärt om.

This paper treats issues of transparency and professional strategies as expressed in the Swedish use and debate of national quality registries in health care. It recounts the story of how the registries were first started by medical professionals to improve treatments, then favoured by public agencies striving to enhance quality of care, and subsequently highlighted by new types of actors as a means to enhance efficiency and patient choice. The paper analyses how the meaning and realisation of transparency are accomplished by different actors. It identifies three relevant aspects of transparency – medical, reflexive and public transparency – each introduced during a different period in the development of the registries.

From the perspective of managerialism, the professional as manager is something of an oxymoron. Within this influential ideology, managers are seen as crucial to organizational success, while professional groups are considered notoriously negligent of overall organizational goals. Even outside this framework, in practical as well as in research oriented literature, the professional as manager is typically discussed in terms of role-conflict, contradictory demands and incompatible identities. In this study of physician leadership, a quite different picture of the professional as manager emerges, where professional commitment and managerial involvement are actually integrated. The empirical inquiry deals with physician heads of department and section managers at a Swedish teaching hospital. Three medical departments and their evolution from the middle of the 1940s to the end of the 90s were studied, with extensive interviewing, archival study and participant observation.

The physician managers studied exposed a range of combinations of personal and managerial influence, with various degrees of participation. For all examined leaders, however, the profession was clearly an important basis of influence. Furthermore, all leaders were actively engaged in organizational matters, not the least since organizational arrangements were important to medical specialty groups. The results lend support to the suggestion that assuming managerial positions may be a new professional strategy. In conclusion, professional identity need not be an obstacle to organizational leadership; in fact, the two roles can be successfully combined, to the benefit of professional subgroups and possibly to health care organizations in general.

This study explores specialization and leadership in the medical profession. Previous research shows that medical specialization leads to increased collegiality and competition within the profession and, to various degrees, in relation to other occupational groups. The objective is to find out how this affects physician leadership in health care organizations and how professional collegiality and competition are related. Leaders’ influence on the course of specialization is also investigated, as well as the relative influence of technological and social factors on the process. The empirical inquiry consists of three longitudinal case studies of medical departments at a teaching hospital that have been studied through extensive interviews, observations and examination of written records.

The results indicate that professional collegiality in the wake of specialization has made physician leadership more participative, democratic and sometimes shared, particularly in specialties cooperating with relatively independent occupations. As the study shows, this can be reinforced by modest professional competition, whereas intense competition limits collegiality, fostering a person-based or even charismatic leadership for rivaling specialist groups. The study supports that specialization is driven both by technological and social factors. However, it also demonstrates that new technology can actually force organizational change, thus creating occasions for leaders to emerge and influence nascent specialty structures. Contrary to the common understanding of charisma and organizational change, the most fertile ground for charismatic and culturally influential leadership turns out to be groups of recognized specialists that are challenged and rally around an inspiring leader who defends the established order.