Purpose: The internal customer concept is used with different definitions and purposes in research and in practice – an ambiguity with implications for both scholars and practitioners. The purpose of this study is, therefore, to explore the representation of the internal customer concept in quality management literature and reflect on how the user may affect collaboration in health-care processes, in particular between a service function and health-care staff.

Design/methodology/approach: A review of the internal customer concept in the literature, followed by a conceptual discussion based on previous studies and theories of organizational discourse.

Findings: Three predominant types of relationships related to the internal customer concept were found. The study shows that the ambiguity in the use of the concept may have consequences for the interpretation and application of research results. Potential undesirable consequences with regard to collaboration in processes are discussed.

Originality/value: This study contributes to a new understanding of the internal customer concept in research and practice. As collaboration within and between organizations is increasingly required in many parts of health care, careful considerations become necessary regarding concepts used for relationships to avoid sub-optimization and “us-versus-them” thinking and to strengthen trust-based relationships.

BackgroundThe purpose of the study was to contribute to research and practice on how the use and exchange of knowledge can facilitate change in health care, specifically methods supporting managers. The study also aimed to investigate barriers related to governance principles that may affect organizational ability to improve quality of care. To achieve the purpose, the study followed a project of hospital-based home rehabilitation after a stroke at a hospital in Norrbotten County, Sweden.

MethodsSeven individual interviews were performed to obtain information from the project members and the managers involved in the project. A group interview with the team and their immediate manager were conducted after the project ended. A thematic analysis was performed to identify and present patterns that formed the results of the study.

ResultsThe study shows how knowledge was identified, gathered, used, and disseminated in the project. The analysis pointed out how knowledge played an important role from two perspectives: in evidence-based practice in rehabilitation work and for change management. Knowledge exchange and learning across organizational boundaries increased the pace, efficiency, and effectiveness, but collaboration on knowledge, in the sense of joint activities based on a common purpose, only took place within the rehabilitation work. Furthermore, there were indications that governance principles, such as the distribution of financial responsibility and the requirements for official recommendations, influenced the pace of change.

ConclusionsIt was shown that the exchange of knowledge and collaboration can facilitate change in health care, but that communication needs to be planned and prioritised. Readiness for change was the basis for the success of the project and for ensuring commitment among those involved. There is also a need for the management to understand how governance principles may affect the efficiency of change work.

Svensk hälso- och sjukvård står inför utmaningar att möta ändrade behov, nya behandlingsmetoder och ny teknik. Genom samordning och samverkan antas kvaliteten för patienten kunna förbättras samtidigt som kostnader reduceras. Organisatorisk samverkan innebär att aktörer, över organisatoriska gränser, tillsammans försöker uppnå syftet med samverkan, t.ex. att underlätta vården av en patient eller patientgrupp i en vårdkedja. Reformer av styrningen har dock påverkat förutsättningarna för organisatorisk samverkan.Avhandlingen beskriver hur ökad förmåga att styra mot uthållig organisatorisk samverkan kan främja effektivare hälso- och sjukvårdsprocesser. I fyra studier utforskas hur några styrprinciper påverkat organisatorisk samverkan, vilka arbetssätt som kan motverka negativa konsekvenser av dessa styrprinciper och hur systematiskt förbättringsarbete ur ett systemperspektiv kan främja initiering, genomförande och utveckling av organisatorisk samverkan. Studierna utforskar olika former av samverkan; (I) intra-organisatorisk samverkan mellan en servicefunktion och vårdverksamheter, (II) inter-organisatorisk samverkan i en försörjningsprocess, (III) kunskapsutbyte i ett förbättringsarbete och (IV) hur ett marknadsbaserat begrepp som intern kund kan inverka på samverkan i en vårdprocess. Kvalitativa metoder har använts för insamling och analys av data, förutom olika typer av intervjuer även granskning av officiella dokument samt en strukturerad litteraturgenomgång och en konceptuell diskussion.Avhandlingen utforskar några styrprinciper som studierna indikerat kunna påverka organisatorisk samverkan. Strävan mot en sömlös vårdkedja kan motverkas av betoningen av gränser inom och mellan organisationer. Strävan efter ökad kvalitet baserat på bevis kan motverka ambitioner av ökad takt i förbättringsarbetet. Strävan efter ett gemensamt ansvarstagande i värdeskapande för patienten kan motverkas av interna marknader och en marknadsbaserad diskurs. Krav på kostnadskontroll kan motverka strävan mot systemövergripande kostnadseffektivitet och måleffektivitet. Arbetssätt som främjar uthållig organisatorisk samverkan baserad på tillit och ömsesidighet kan dock motverka de negativa konsekvenserna. Strukturerad kommunikation, incitament genom gemensamma mål och indikatorer, uppföljning av dem och utvärdering av samverkan kan främja pågående, nya och förnyade samverkansaktiviteter. Nedtoning av en marknadsbaserad diskurs och betoning av det ömsesidiga ansvaret kan synliggöra servicefunktionernas roll i värdeskapande för patienten. Avhandlingen visar också att organisatorisk samverkan kan främja förbättringsarbete och lärande i processer genom delande av kunskap inom och mellan funktioner och organisationer. Arbetssätt baserade på teorier om organisering, kvalitetsledning, systemtänkande och processledning kan stödja organisationerna vid initiering, genomförande och utveckling av samverkan inom och mellan organisationer. 

Integrating health care services has proven to be important from both the patient and organizational perspectives. This study explores what defines a perceived well-functioning collaboration in the inter-organizational process of providing assistive devices in Sweden. Two focus groups comprising participants with profound knowledge of collaboration were performed, and data were analyzed in five steps, resulting in a data structure. Results yield the identification of three interacting processes: coordinating efforts to patient needs, ensuring evidence-based practice, and planning for efficient use of resources. These processes affected one another, and, therefore, would likely not have been effectively managed separately. The study contributes to theories of process management and organization by specifically focusing on how to analyze and improve sustainable collaboration in health care processes at both the management and professional levels. Theoretical frameworks that show different ways of organizing collaboration, as well as the concepts of action nets and boundary objects, can support both analysis and planning of collaboration. The intention would be to develop integration in inter-organizational health care processes, resulting in more person-centered care.

PurposeThe use of the customer concept and ways of interacting with customers in support functions are relatively new areas of interest for public organizations. The aim of this study is to describe the development towards a stronger customer orientation in a support function in a Swedish county council from a management team perspective.Design/methodology/approachA revision of plans and annual reports and individual interviews with the members of a management team was done. The interviews were examined using qualitative content analysis.FindingsThe results are presented in one overarching theme: the double-edged customer concept, and three themes: meeting the customer’s needs, being the customer’s specialist, and developing in collaboration with the customer. The development of a customer orientation is illustrated as a spiral involving the concepts of understanding, wanting, and acting.Originality/valueThe paper contributes to new understanding of how customer orientation develops in the context of public organizations’ support functions.