Between power and powerlessness – discourses in the individual plan processes, a Norwegian dilemma

Abstract

The purpose of this article is to explore what may cause tensions in the work with IP processes and discuss this in the light of power and powerlessness. The project is designed as a multi-case study. Qualitative data were collected through semistructured individual interviews and observations from group meetings. Quantitative data were collected through a questionnaire focusing on activities of daily living, as well as from documents such as the available individual plan itself and official minutes of the meetings. The analysis of the material is based on a sociological discourse analysis. The three power discourses disclosed were power of knowledge, power of language, and power of definition. Power of knowledge refers to the clients' expert knowledge of themselves as well as the professionals' knowledge whereas the informants experienced power of language, as a physical, psychological, and social instrument to present the client's case. The holder of power of knowledge and power of language possesses the power of definition regarding the individual plan process, but the study revealed nuances in this relationship. More attention and self-awareness should be paid to the relationship between the trust professionals are given by the clients and the position of power this entails when collaborating in IP processes.

Young and Midlife Stroke Survivors’ Experiences With the Health Services and Long-Term Follow-Up Needs

“…Although all Norwegian patients in need of coordinated care have the right to an individual plan (Ministry of Health and Care Services, 2009; Norwegian Directorate of Health, 2010), either it was not offered or it was considered to be unhelpful. The challenges of this tool have also been reported elsewhere Slettebø et al, 2012).…”

Current status of rehabilitation activity and the new health care reform in Norway

“…Besides the new Coordination Reform aiming to address discrepancies such as these, the individual patient's right to optimal and individualized treatment is ensconced in an individual plan which applies to all age groups (Thommesen 2004). The latter is also supposed to enhance collaboration between the patient, public services and the various health care professionals (Alve et al 2013;Slettebø et al 2012).…”

“…In Norway, as in the rest of Scandinavia, the Ministry of Health and Care sets out policy guidelines. By contrast, the Directorate of Health sets out specific regulations which, among others, clearly stipulates the rights of the patient to receive optimal and individualized treatment and care by way of the individual plan (Thommesen 2004;Alve et al 2013;Slettebø et al 2012).…”

Working with Individual Plans: users' perspectives on the challenges and conflicts of users' needs in health and social services

“…The IP process also exposed difficulties related to manoeuvring within the health and social systems, focusing on various pieces of legislation, different interpretations, different management levels and different levels of attention to cooperation, thus encapsulating the tension between the individual and the framework of health and social services (Hansen 2007;Slettebø et al 2011). The participants created different solutions; however, difficulties remained unsolved.…”

“…However, the introduction of IPs could also be perceived as an attempt to remedy the ineffectiveness of the public health services and to minimise the cost of the same services influenced by the New Public Management (NPM) strategy (Hansen 2007). These different agendas highlight the possible appearance of tensions and conflicts between different actors and within the services when implementing IPs, some of which have been addressed in earlier publications (Slettebø et al 2011;Alve et al 2012).…”