Organising for trust and control between public and private actors in elderly care services

Management based on trust has been called for as a means of improving welfare services in Sweden.

In situations where public purchasers and private providers interact, such forms of management become rather complicated. Customer choice markets have been introduced in more than half of Swedish municipalities, but the trend is now turning.

Research has begun to pay attention to such quasi markets but much more is needed to comprehend their consequences and learn what forms of management that lead to sound control and trust, or distrust and increasing costs, respectively.

The aim of this project is to contribute to knowledge about the interplay between trust and control between purchasers and providers in customer choice systems by means of exploring how functional and dysfunctional trust and distrust develop over time and in different contexts.

The project is designed as a comparative case study comprising two Swedish municipalities with extensive experiences of difficulties concerning the management of private providers of care.

One of the municipalities has recently introduced a customer choice model and the other has more than ten years of experience.

In the latter, more than half of the private providers have been excluded from the customer choice system in a period of five years due to distrust. Vast resources have been spent on controls, causing decisionmakers to question the very fundaments of the system. Is it possible to restore trust in private providers in such a situation, and if so, how?

Access is established and ensures relevant case material.

The forms of organising used to provide elderly care and manage private providers have a huge impact on both the recipients of care and the employees in the sector.

What is at stake here is basically the very question of what constitutes good elderly care, how it is to be performed and by whom. Given the experiences learned from the covid-19 crisis, these are truly important matters to tend to.