Tackling-health-inequities-from-concepts-to-practice-The-experience-of-Vastra-Gotaland

the implementation of their decisions will depend on decisions made byother bodies. Failures to implement a certain strategy or actions are thus notnecessarily due to what happens in one’s own organization but could well bethe result from strategies and decisions at other levels by other actors (14).This is a main reason as to why a common recommendation for work withinthe field of public health is to emphasize coordination and concerted actionby many different stakeholders within the scientific, public, professional andcivic societies (8). To develop the Action Plan, it was necessary to organize andcollaborate with a network of actors in the Region. 2 In the following section, thethree domains that together form human service organizations are described tobetter understand the limitations and possibilities inherent in the collaborativenetwork that evolved in the regional process. It is clear that a decision is notthe result of a linear procedure but rather from a situation where a number ofconditions coincide, by chance or deliberately. The process itself was evaluatedusing an actor-network theory to analyse the development process and toidentify successes and mistakes. The core of this theory is also accounted for.The three domainsIn their often cited paper, Kouzes and Mico suggest that human serviceorganizations comprise three distinct domains – policy, managment and service– rather than an all-including hierarchy and a linear decision-making process(15). Each of the three domains operates by different principles and rationales,measures of success, work mode and structures (Table 1). These conflictingprinciples are important explanatory factors to understand the difficulties thatemerge when political decisions are to be implemented into action.Table 1. The three domains of human service organizationsDomain Principles Success measuresPolicy Consent of the governed EquityManagement Hierarchical control and coordination Cost efficiency and effectivenessService Autonomy and self-regulation Quality of service, good standardsand practiceSource: information based on Kouzes & Mico (15).2An overview of the organizations involved is in Section 4.Section 3. Theoretical framework11