Trust and collaboration in hybrid home care organization' staff empowerment or subordination
Welfare policies and inclusion NOVA - Norwegian social research Oslo, Norway
In the wake of the NPM trend of modernizing public government, many countries have experienced shortcomings and adverse effects of reforms. Pragmatic solutions and new reform models are put on the agenda, stressing joined up governance, horizontal governance and other multi-stakeholder arrangements. These new images readily bring to mind the idea of repairing or putting back together something that is broken (Christensen & Lægreid 2007). From a Nordic perspective they have a nostalgic reverberation as they tend to raise questions which were at the forefront in reforms dominating the pre-NPM era.
This paper explores the way in which the comeback of ?old? organizational ideas -- stressing mutual trust and collegial collaboration -- are repackaged and put into practice. To what extent and in which ways are they challenged by or subordinated to previous governance models paying attention to the vertical dimensions of welfare organization? Empirical examples draw on case study data from the Norwegian home care sector, from two different city wards, both of which had organized home care according to purchaser provider model; both of which had realized that collaboration and latitude was needed in order to meet the complex and shifting needs of care recipient. The idea that service providers should be held accountable through contractual relationships with a purchaser unit was rejected and efforts were made to (re)establish trust and collaboration between purchaser and providers.
The case studies indicate that collaboration based on mutual trust and transparency open up for care giver staff to act in accordance with their own professional and ethical standards. However, they also expose that tenets of NPM are robust. Officials stick to their belief in efficiency through benchmarking and to the quantification myth i e that everything relevant can be quantified. The paper argues that the institutional dynamic of change is best understood as a complex mixture of external and internal pressure from a range of actors at different levels who possess different forms of power and knowledge. The process of governance is characterized by conflicting models and the point of balance between them may vary between different care districts.