Linköping University, Sweden.
Health (London). 2022 Nov;26(6):681-701. doi: 10.1177/1363459320976757. Epub 2020 Dec 8.
The interface between the patient and the health service has changed, which constitutes a potential problem for various policy-makers. Using a critical policy perspective and drawing on the theory of problem framing, this paper explores how actor groups with different responsibilities perceive the patient as a constructed policy problem. This is a qualitative study where data consists of single episode interviews with healthcare politicians, senior administrators, service strategists, and unit mangers from one regional health authority in Sweden. A thematic content analysis of the interviews was carried out in accordance with "the framework approach". The study illustrates how the actors interpret their reality using diverse problem frames. This becomes more visible when the framing is disentangled with regard to what perspective they employ in relation to different accounts: society or the individual, or the (healthcare) system or the (healthcare) professional. The actor groups are part of the same institutional context, which explains certain tendencies of similarities in terms of the accounts being used, but still they approach the constructed problem differently which is visible as shifts-scaling up and down-between different accounts. By analyzing and structuring the various problem frames (including its policy styles) we can enhance our knowledge about how those responsible for the governance of healthcare approach the patient as a policy problem, as something that concerns only the patient and/or the provider, or as something that needs to be addressed in broader strategic terms.
医患关系发生了变化，这对各类政策制定者构成了潜在问题。本文运用批判性政策视角，并借鉴问题构建理论，探讨了具有不同责任的行为群体如何将患者视为构建政策问题。这是一项定性研究，数据由瑞典一个地区卫生当局的医疗保健政治家、高级管理人员、服务策略师和单位经理的单次访谈组成。根据“框架方法”对访谈进行了主题内容分析。研究表明，行为者如何使用不同的问题框架来解释他们的现实。当根据他们在不同账户中使用的视角（社会或个人，或系统或专业人员）来分解框架时，这种解释就更加明显了。这些行为群体属于同一制度背景，这可以解释在使用的账户方面存在某些相似趋势的原因，但他们仍然以不同的方式处理构建的问题，这表现在不同账户之间的上下波动（缩放）。通过分析和构建各种问题框架（包括其政策风格），我们可以更好地了解负责医疗保健治理的人员如何将患者视为政策问题，是仅与患者和/或提供者有关的问题，还是需要从更广泛的战略角度解决的问题。
