The structuring of management control in Swedish home care units : An explorative discourse study

Abstract: Background. The research on management in Swedish home care has been conductedmainly from sociological perspectives where structural conditions have been of interest (see for example Hagerman et al., 2013; Andersson, 2014; Österlind, 2013). The conditions impacting on management are described as differing ideals where the main ideals are the care perspective and the cost perspective (see for example Andersson, 2014; Österlind, 2013). The conflict between ideals create tensions between ideology and practice and different expectations (Antonsson, 2013) and may also create problems, dilemmas and paradoxes (Österlind, 2013). The rules impacting on the home care activities are bureaucratic rules stemming from the state and municipality. However, Trydegård (2000) argues that at the same time there is room for autonomy and path-dependence in the home care units. Purpose and research approach. There seems to be a lack of studies on management control in home care, and more especially no study combining a discourse, structures and theories on management control. The purpose of this thesis is to explore management control in home care in the relation between structures and managers’ interpretative repertoires in a social-constructionist perspective. The purpose is also to create a prototype model for further research. The ontological positioning and theoretical framework are building on Giddens’ structuration theory (1979, 1984) in which structures are seen as both the medium and outcome of social interaction and rules are important. The units of analysis are the managers’ accounts on management control in semi-structured interviews. The accounts are analysed in a so called case cluster analysis (McClintock et al., 1979) in the software program NVivo. The codes are building on Ouchi’s theory of management control (1979) as ‘input control’, ‘behaviour control’, ‘output control’ and ‘clan control’, and also building on Giddens’ structuration theory (1978, 1984) defined as 8 characteristics of rules, ‘normative sanctions’, ‘signification of meaning’, ‘authoritative’ or ‘allocative resources’. Findings. The findings reveal that home care is highly bureaucratic in input and output control by the use of formal rules stemming from municipality or state. In behaviour control home care has a medium-low degree of bureaucracy if exercised through ‘signification of meaning’ and medium-high when exercised through ‘authoritative resources’. In clan control home care has a low degree of bureaucracy and can either be positive or negative depending on how informal leaders in the unit impact on cooperation between care personnel and if there is trust and a good communication between manager and care personnel. Two main patterns of structuration appear: creation of structures for an efficient process flow of home care to increase efficiency, and co-creation of new rules for behaviour to increase cooperation. Managers focus on different situations of management control depending on conditions in the home care unit and own interpretations. Two interpretative repertoires are identified; the discourse on hard matters is created in relation to matters that are more rigid in structure, such as legislation and municipal goals and that are difficult to interpret differently, whereas soft matters are created in discourse around dilemmas and human or relational aspects of control.