The impact of Covid-19 on inter-organizational coordination in Swedish eldercare: a mixed methods study.

Abstract

Background: In Sweden, healthcare provision for the frail elderly entails coordination between municipalities and regions. Despite formal agreements, deficiencies persist in achieving practical coordination, leading to adverse effects on patients and increased costs. The Covid-19 pandemic further strained the health- and social care system, exposing shortcomings in eldercare coordination. This paper explores the impact of crises on inter-organizational coordination between long-term organizational collaborators, operationalized through medical care coordination in Swedish nursing homes during the Covid-19 pandemic.

Methods: The study examines coordination between regionally employed physicians and municipal nursing home nurses through a mixed methods approach. A survey was sent to regional physicians and municipal nurses working in eldercare, as well as managers at both nursing homes and healthcare centers. A total of 170 responded to the survey, and 20 participants took part in a subsequent follow-up interview.

Results: Findings indicate that medical care coordination was perceived to have functioned relatively well during the pandemic and even to have improved afterward. Key factors contributing to this outcome include the adoption of innovative solutions, such as digital technologies, to address both staff shortages and increased demand brought on by the crisis. Trust and shared cultural values among staff fostered collaboration, while personal engagement became crucial when compatibility was lacking. The respondents also highlighted improved communication channels and enhanced coordination as a means to combat uncertainties during the crisis.

Conclusions: The perception of well-functioning crisis coordination among the respondents contrasts with more critical views in general society. This discrepancy might be attributed to different expectations during crises; healthcare professionals adhere to specified standards, values, and beliefs within their specialized cultures. Healthcare professionals might therefore have a more nuanced perception of what they believe constitutes good medical care coordination. The contributions of this study include integrating the crisis management literature with inter-organizational coordination in healthcare. The approach provides new insights to clarify the impact of crises on medical care coordination and identify important factors regarding inter-organizational coordination during crises.