Towards a sustainable healthcare system: Transformation through participation
Book chapter, 2011

This chapter examines the developmental journey toward a sustainable healthcare system in the west of Skaraborg County in Sweden from 2000 to 2010. It tracks a stream of collaborative research projects within the context of the Swedish sustainability debate that were focused on achieving improved care quality, patient safety, efficiency, and efficacy. The case reports how a central government directive to integrate healthcare at the local level – the county – led to the establishment of a development coalition management group that designed and managed the transformation via broad participation and engagement mechanisms. The transformation process toward a more sustainable healthcare system raises theoretical and practical questions about sustainable effectiveness, the role of partizcipation and learning mechanisms such as democratic dialogue conferences in sustainable effectiveness, the tension between planned and emergent change processes, and the challenge of integration in the drive toward a sustainable healthcare system.


Learning mechanisms

Sustainable healthcare system


Democratic dialogue conference


Development coalition

Sustainable effectiveness


S. Lifvergren

Skaraborg Hospital

Peter Docherty

Chalmers, Technology Management and Economics, Quality Sciences

A.B. Rami Shani


Organizing for Sustainable Effectiveness

2045-0605 (ISSN) 2045-0613 (eISSN)


Subject Categories

Health Care Service and Management, Health Policy and Services and Health Economy



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