Exploring the effectiveness of the coordinated individual plan in Sweden: challenges and opportunities for collaborative care

Abstract

ABSTRACT The increasing specialization and differentiation within welfare organizations in Sweden and internationally have, due to fragmentation and inflexible boundaries, resulted in ineffective care for users. In order to improve care, the Coordinated Individual Plan (CIP) was introduced by the government in Sweden in 2009, with the aim of improving collaboration between social service and health care. Persons with concomitant mental health problems and substance abuse were one of the target groups. Earlier studies by the authors indicate that CIP has had limited impact. Use of CIP has been unsystematic and the user/patient’s role less central than expected. This study investigates what can contribute to these findings, based on professionals’ experience of their participation in CIP. Interviews were conducted with 20 professionals in the social service and health care sectors and analysed by qualitative content analysis, using the theoretical perspectives of institutional isomorphism. Findings indicate that, while the professionals were positive about the idea of CIP to improve the situation for the individual user/patient, coercive isomorphism in the form of CIP also led to a more confrontational view of collaboration which does not necessarily solve problems for the individual. Organizational and professional perspectives were cited, which can be linked to issues of organizational uncertainty. The study confirms earlier findings indicating that a stronger, team-based model is needed, with development based on professional experience, as the coercive aspect tends to take precedence over professional activities connected to mimetic and normative isomorphism.