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AbstractThis article analyzes the emergence of the Swedish "national system for knowledge‐driven management." We argue that the system is best understood as a meta‐instrument that is underpinned by an "instrument constituency," a coalition held together by a joint interest in a particular policy solution. Based on interviews and documentary analyses, we show the conflicting interests that are included in the constituency and how the functional effectiveness of the meta‐instrument is exposed to a number of risks that follow from its specific implementation and from the heterogeneity among its constituency. In particular, we point to the threats against professional learning, responsibility, and integrity.Related ArticlesSelling, Niels, and Stefan Svallfors. 2019. "The Lure of Power: Career Paths and Considerations among Policy Professionals in Sweden." Politics & Policy 47(5): 984–1012. https://doi.org/10.1111/polp.12325.Shen, Yongdong, Meng U. Ieong, and Zihang Zhu. 2022. "The Function of Expert Involvement in China's Local Policy Making." Politics & Policy 50(1): 59–76. https://doi.org/10.1111/polp.12450.Svallfors, Stefan, Erica Falkenström, Corrie Hammar, and Anna T. Höglund. 2022. "Networked Reports: Commissioning and Production of Expert Reports on Swedish Health Care Governance." Politics & Policy 50(3): 580–97. https://doi.org/10.1111/polp.12462.

Background By tradition, the Swedish health care system is based on a representative and parliamentary form of government. Recently, new management forms, inspired by market principles, have developed. The steering system is both national and regional, in that self-governing county councils are responsible for the financing and provision of health care in different regions. National and local documents regulating Swedish health care mention several ethical values, such as equity in health for the whole population and respect for autonomy and human dignity. It is therefore of interest to investigate the status of such ethical statements in Swedish health care management. Method The aim of the present study was to investigate perceptions of the status of ethics in the daily work of politicians, chief civil servants and Chief Executive Officers (CEOs) from care-giver organizations in the county council of Stockholm. A qualitative method was used, based on inductive content analysis of individual interviews with 13 health care managers. Results The content analysis resulted in four categories: Low status of ethics; Cost-effectiveness over ethics; Separation of ethics from management; and Lack of opportunities for ethical competence building. The informants described how they prioritized economic concerns over ethics and separated ethics from their daily work. They also expressed that they experienced that this development had been enforced by the marketization of the health care system. Further, they described how they lacked opportunities for ethical discussions, which could have helped develop their ethical competence. Conclusions In order to improve the status of ethics in health care management, ethical considerations and analyses must be integrated in the regular work tasks of politicians, chief civil servants and CEOs; such as decision-making, budgeting and reform work. Further, opportunities for ethical dialogues on a regular basis should be organized, in order to improve ethical competence on the management level. New steering forms, less focused upon market principles, might also be needed, in order to improve the status of ethics in the health care management organization.

This paper analyses the process in which expert reports on health care governance are commissioned, produced and received in a Swedish setting. Based on an empirical analysis of interviews with commissioners and producers of such reports, the paper argues that the typical process in which expert reports on health governance come about is fraught with quite deficient ways of producing expert knowledge. The analysis contributes to the literature on the role of expertise in governance and policymaking. In contrast to most other analyses in this field, the paper focuses not on the content of expert reports nor on their political uptake but on the process in which they are produced.

AbstractThe article analyzes the commissioning and production of expert reports about Swedish health care management and governance. We show that these reports are rarely solitary stand‐alone products, but tend to form clusters in an evolving discourse centered around specific policy solutions. We also show that the most important producers of such reports tend to come from a small circle of informally recruited academics and policy experts representing a narrow segment of academic disciplines. We point to some of the risks involved in this structure of knowledge production and argue that reports: (a) may form their own environment rather than address real problems; (b) may reproduce certain taken‐for‐granted assumptions and critical lacunae; (c) may have their impact decided by their network connections rather than by their intellectual content; and (d) represent a structure that provides opportunities for special interests to enter the process.Related ArticlesCaliskan, Cantay. 2020. "The Influence of Elite Networks on Green Policy Making." Politics & Policy 48(6): 1104–37. https://doi.org/10.1111/polp.12382Selling, Niels, and Stefan Svallfors. 2019. "The Lure of Power: Career Paths and Considerations among Policy Professionals in Sweden." Politics & Policy 47(5): 984–1012. https://doi.org/10.1111/polp.12325Shen, Yongdong, Meng U. Ieong, and Zihang Zhu. 2022. "The Function of Expert Involvement in China's Local Policy Making." Politics & Policy 50(1): 59–76. https://doi.org/10.1111/polp.12450