The Alleged Culprit of Poor Coordination of Integration of Health and Social Care Services for Very Ill Older Persons in Sweden, 2000-2022

Abstract

Despite numerous attempts to transform Swedish older adult care, similar problems regarding its coordination have persisted over the years. This literature review aims to identify which coordination mechanisms can be perceived as the alleged culprit of poor coordination of integrated health and social services for seriously ill older individuals in Sweden between 2000 and 2022. Classical and contemporary coordination theories are utilised to pinpoint these coordination mechanisms, and the analysis is based on the content of collected articles from this thematic area. This literature review reveals that the following coordination mechanisms are perceived as the primary cause of poor coordination in older adult care: (1) plans, programmes, rules, and standardised work processes. Research has confirmed that decentralisation, the autonomy of regional and local authorities, new regulations implemented in the spirit of NPM, and double principalship have hindered care integration for seriously ill older adults; (2) roles, standardisation of skills, and direct supervision. Neither organisational principal adequately addresses excess employee workloads and an insufficient number of employees providing care services, which generates stress, conflicts, and even occupational burnout among staff. They do not prioritise staff competency development; (3) proximity, feedback, and adjustments through mutual communication. Most studies have shown that communication among staff is crucial to achieving integration, but it could be more effective among staff members involved in providing care. Knowledge about “objects and representations” and “routines and standardisation of outcomes” is somewhat limited and deserves further research.