Costs will rather increase

Abstract

Purpose The purpose of this paper was to study the unfolding of an urgent and extensive decommissioning program in Sweden, focusing on the public’s reactions and their arguments when opposing the decommissioning activities. Design/methodology/approach The public’s responses were studied through local media. Its content was surveyed and divided into actions and arguments. The arguments were further analyzed and categorized into inductively developed themes. Findings Protest activities, such as demonstrations, meetings and petitions, were not coordinated, but mostly carried out for withdrawals of unique services and services in remote areas. The public questioned the decision makers’ information, calculations and competence, the adequacy of the consequence analyses and whether the decommissioning activities would lead to any real savings. Patient and public safety, the vulnerable in society, and effects on the local areas were important topics. Thus, it seems the decision makers did not fully succeed in communicating the demonstrable benefits or create clarity of the rationales for decommissioning the particular services. Furthermore, it seems the public has a more inclusive approach to health services and their value compared to decision makers that need to keep the budget. Originality/value Decommissioning is an emerging field of research, and this study of the unfolding of an urgent and extensive decommissioning program contributes with evidence that may improve decommissioning policy and practice. The study illustrates that it may be possible to implement a decommissioning program despite public protest, but that the longer-term effects on the health system’s legitimacy need to be studied.

Putting a decommissioning programme into action: an interview study with politicians and public servants in a local healthcare organisation

“…In 2020, a national evaluation reported that Region Dalarna had the lowest healthcare cost per inhabitant among Sweden’s 21 regions (KOLADA, 2020). Furthermore, there was, unexpectedly, little resistance from the clinics and clinic managers involved in the decommissioning activities in relation to the many and extensive changes they had made (KPMG, 2016; KPMG, 2018; Fredriksson and Moberg, 2018). A national evaluation indicated a positive trend in quality of care for the primary care, surgery, and medicine divisions during the decommissioning processes, as well as in indicators of patient safety (Yang and Buijs, 2019).…”

A New Way of Thinking and Talking About Economy: Clinic Managers’ Perspectives on the Sustainable Implementation of a Decommissioning Programme in Sweden

“…This fact may have influenced them to think of the decommissioning programme as successful in terms of balancing the economy. 27 , 28 Hence, longitudinal studies may be appropriate to further study the sustainability of this type of programmes and we suggest this approach for future studies. Lastly, because we exclusively interviewed CMs, who may naturally focus on events closely related to the clinic, this could have led to an underestimation of factors of importance situated further away, for example, at the political level or the role of interest groups.…”

Clinic managers’ perspectives on the sustainable implementation of a decommissioning programme in Sweden: a qualitative study

“…One such potential driver in this case may be that, at the time of the interview, the clinic managers were aware that the region's economy had improved considerably. This fact may have influenced them to think of the decommissioning programme as successful in terms of balancing the economy (29,30). This change required reformulation of the programme, which was performed by the CMs rather than the region leadership.…”