حکومت، مسئولیت پذیری و توسعه سازمانی: تجارب مدیران اداری و سیاستمداران Eldercare و پاسخگویی به نظارت دولتی Eldercare سوئد Governance, Accountability, and Organizational Development: Eldercare Unit Managers’ and Local Politicians’ Experiences of and Responses to State Supervision of Swedish Eldercare

Background and aim The health and social care of the elderly is a policy priority and a major area of state and local government expenditure in most welfare states. In recent decades, the area has been strongly affected by economic, ideological, and organizational changes, not least due to population ageing. Swedish eldercare is conducted in increasingly downsized organizations (Bengtsson, 2010; Szebehely, 2011; Szebehely & Trydegård, 2012) incorporating progressively more market elements and private providers alongside public providers (Meagher & Szebehely, 2013; Stolt, Blomqvist, & Winblad, 2011). State supervision (SSV) of Swedish eldercare has recently been strengthened to ensure better compliance with laws and regulations. Two state commissions investigated the potential to enact a standardized, strengthened, and systematic SSV model for social work in general (SOU, 2004; p. 100, 2007; p. 82). Supervision was strengthened in response to exposures of inhumane care and unequal distribution of eldercare with the aim of ameliorating unhealthy conditions and creating trust in eldercare. Recurrent monitoring of compliance by means of laws and regulations is expected to ensure equal distribution of safe, high-quality eldercare (Socialstyrelsen, 2011), and there are expectations that SSV can ensure and improve quality in both public and private eldercare services (Blomgren & Waks, 2011; Ek, 2012; Johansson, 2011; Lindgren, 2016; Lindgren, 2012). Increased state regulation and control to improve quality in welfare services reflect an international trend (Furness, 2009; Hood, 2012; Power, 2003). However, the issue of whether SSV is an effective way to improve quality in eldercare is debated (Beddoe, 2012; Cooper, 2006). Critics warn that external supervision can negatively affect professions in that it creates mistrust and lowers the level of confidence (Beddoe, 2012; Cooper, 2006). Research into how SSV operates in practice and how it is conceived and reacted to by the supervisees is scarce. Research into SSV and inspection exists (Nygren & Hanberger, 2011; Hämberg, 2013; Hood, Oliver, Scott, & Travers, 1999; Johansson, 2006, 2010; May & Wood, 2003; Power, 1997, 2003), but research from the eldercare field specifically is rare (Braithwaite, Makkai, & Braithwaite, 2007; Ek, 2012; Furness, 2009).