Being bound and tied by the ropes of frugality: a case study on public management values and service integration

Therese Dwyer Løken,Marit Kristine Helgesen,Catharina Bjørkquist,Halvard Vike

doi:10.1108/jhom-10-2020-0401

Therese Dwyer Løken, Marit Kristine Helgesen + Show 2 more

Open Access

https://doi.org/10.1108/jhom-10-2020-0401

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Abstract

New Public Management (NPM) has increased fragmentation in municipal health and social care organizations. In response, post-NPM reforms aim to enhance integration through service integration. Integration of municipal services is important for people with complex health and social challenges, such as concurrent substance abuse and mental health problems. This article explores the conditions for service integration in municipal health and social services by studying how public management values influence organizational and financial structures and professional practices. This is a case study with three Norwegian municipalities as case organizations. The study draws on observations of interprofessional and interagency meetings and in-depth interviews with professionals and managers. The empirical field is municipal services for people with concurrent substance abuse and mental health challenges. The data were analyzed both inductively and deductively. The study reveals that opportunities to assess, allocate and deliver integrated services were limited due to organizational and financial structures as the most important aim was to meet the financial goals. The authors also find that economic and frugal values in NPM doctrines impede service integration. Municipalities with integrative values in organizational and financial structures and in professional approaches have greater opportunities to succeed in integrating services. Applying a public management value perspective, this study finds that the values on which organizational and financial structures and professional practices are based are decisive in enabling and constraining service integration.

Highlights

Health and social care reforms are aimed at organizational renewal (Pollitt, 2013), and they carry public management values that change both working conditions for professionals and services for service recipients (Franco et al, 2002)
Our empirical field is Norwegian municipal health and social services, this problematic area may be of interest for other countries
Our theoretical contribution indicates that public management values have implications for organizational and financial structures and professional practice

Summary

Introduction

Health and social care reforms are aimed at organizational renewal (Pollitt, 2013), and they carry public management values that change both working conditions for professionals and services for service recipients (Franco et al, 2002). As in other Western countries, several elements in the health and social care reforms in Norway have been inspired by values of New Public Management (NPM) (Nesvaag and Lie, 2010). Later health and social care reforms known as post-NPM aimed to address the challenges brought on by fragmentation, by enhancing organizational integration and collaboration (Lægreid et al, 2015). These reforms offer additional governance concepts to guide the complex issues that public sector organizations are required to handle, fragmentation due to organizational structures still is a challenge (Steihaug et al, 2016)

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