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This article reviews the traditions of the health care industry while challenged by trends. Strong professions, ambiguous and contradictory aims, and a lack of resources have contributed to difficulties managing contradictory needs. One way to handle the situation is to introduce systems based on freedom of choice, inter organisational and professional work, and an improved degree of flexibility. The trends are mainly influenced by New Public Management control models. The mixture of new and traditional types of management control has produced organisational hybrids. These organisational hybrids have contributed to organisational tensions from the old as well as the new in an inconsistent but regenerating way.

In this article, we studied collaboration exercises (3LC) between the rescue services, ambulance services, and police force, which were developed to enhance learning and usefulness. The exercises' structure was based on identified deficiencies in previous collaboration exercises. The purpose was to test the exercise model in terms of learning and usefulness. Ten 3LC exercises were observed. A total of 65 semi-structured interviews were conducted (2011–2014) in connection with the exercises. The exercises contained across-boundary elements, seminars, and interactive documentation. The participants were given the opportunity to discuss, analyze, and critically reflect on their efforts. During the seminars, the individual actions were analyzed, which led to alternative strategies that were subsequently tested in a repeated exercise. Our results demonstrate that repetitive features and seminars during collaboration exercises promote learning toward an organic behavior and usefulness in the actual incident work.

The aim of the study was to examine the emergency personnel's perception of the effects of exercises, with regard to learning and usefulness. The exercises were quasi‐experimental and constructed in such a way that employees from different organizations overlapped each other's tasks. This was accomplished by: having asymmetries included in the scenarios, repeating exercise procedures and testing different strategies, which were discussed at joint seminars. The exercises were compared to a similar study, published in this journal, of nonquasiexperimental but merely traditional exercises. Surveys were distributed and collected from emergency personnel in connection with seven exercises. At the exercises, 94.3% of the personnel thought that the exercises had a focus on collaboration (traditional exercises, 75.6%).

This article aims to study whether exercises contribute to learning that can be useful in actual emergency work. It reports the findings of a study about professional emergency personnel's perceptions of the impact of collaboration exercises. Surveys were distributed and collected from emergency personnel in conjunction with three collaboration exercises that took place in Sweden in spring 2012. The survey included personnel holding different positions within the police department, fire department and ambulance services. Among them were also operational personnel such as officers. A total of 94 professional emergency personnel agreed to participate by answering the survey. The response rate was 95%. The study shows that collaborative elements in exercises contribute to perceived learning (R2 = 0:53), and that learning, in turn, has a perceived beneficial effect on actual emergency work (R2 = 0:26). The perceived results of collaboration, learning and their impact on actual emergency work, however, are moderate. The exercises were characterised by long waiting times and gave few opportunities to practise different strategies. Only a few respondents felt that they learned something about the collaborating organisations' ways of communicating and prioritising. Many also thought that the exercises were more useful for command officers than for operational personnel. Thus, the study shows that by strengthening the collaborative elements of the exercises, the perception of the participants' actual emergency work can be developed.

PurposeThe purpose of this paper is to study why collaboration among police, fire, and ambulance services is minimised at accident scenes.Design/methodology/approachObservations and semi‐structured interviews were carried out during 2007‐2008. The data material comprises a total of 248 hours of observations on 20 occasions and 57 interviews with 80 people.FindingsThe study identifies the difference between rhetoric and practice in connection with accident work. Collaboration is seen as a rhetorical ideal rather than something that is carried out in normal practice. Asymmetry, uncertainty and lack of incentives are important explanations as to why only limited forms of collaboration are actually implemented.Research limitations/implicationsThe paper shows a distinction between collaboration as rhetoric and practical collaboration at accident scenes.Practical implicationsThe article proposes a multi‐faceted collaboration concept. In this way, collaboration can be developed and refined.Originality/valueThe results of the study show that police, fire, and ambulance services want to develop excellent forms of collaboration at the accident scene, but avoid this as it leads to uncertainty and asymmetries and because of a lack of incentives. However, simpler forms of collaboration may be realistic in the organisation of everyday work at accident scenes.

In this study, a critical examination of collaboration, focusing on the alternatives, is carried out. The study is based on empirical data from four inter‐organizational exercises involving ambulance police and fire departments. We studied collaboration between the three organizations, from the arrival of the first units, until the mission was completed. It was found that collaboration was practiced to a relatively small degree, and that it primarily took place due to understaffing. In summary, the different organizational phenomena are sorted on a scale of stability vs. change. The result of the study shows that the organizations observed strive for stability, preferring repeated and well‐known behaviour.

Abstract
Professionals within street-level organizations are essential for the delivery of public services to citizens. However, among a number of difficult dilemmas, they have to deal with an extensive workload. The police can be seen as a good example of this; they are expected to solve most crimes, including the so-called mass crimes and the more spectacular cases that make it into media headlines, and often on a continually decreasing budget. A key regulating mechanism for investigation departments in the Swedish police is the so-called balance. The balance can be described as a basket in which they put the cases that there is a desire and potential to work on but not in the immediate term. The purpose of this article is to analyse the balance as a way of rationing the workload within the Swedish police. Working with the balance consists of two processes: limiting and buffering the workload. Limiting is the practice of reducing the work in a situation. Buffering is the process of putting some work on hold to deal with later, of which the article identifies five kinds; functional, problematic, quasi, progressive, and symbolic buffering. The exploration of 'the balance' contributes to our understanding of how street level organizations attempt to defend their professional jurisdictions, their well-being, and their ability to complete their duties.