The quality reform of the public sector

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Abstract

In August 2007, the Danish Government launched an ambitious strategy for securing the quality of the public sector in the future. The purpose and expected outcome is better welfare services for the citizens and increased job satisfaction for the public sector workforce.

Purpose of health policy or idea

The main objective of the strategy is to increase the quality of the public welfare services. The strategy consists of 180 different reform proposals that are supposed to bring about change through both financial and non-financial incentives. The proposals are to be implemented in the short, medium and long run. The suggested budget allocations are thus planned to run until 2018. The three highlighted elements of the strategy consist of: 

1. Investments in more welfare through a so-called quality fund with 25 billion DKK (3,4 billion €) allocated to health care over a ten year period and a quality budget allocation with 10 billion DKK (1,3 billion €) for the entire public sector.
2. An increased focus on quality performance indicators in the health care sector.
3. A combined reform package consisting of 8 reforms with 180 different initiatives aimed at improving working conditions and securing high quality in the public sector. 

The quality reform is supposed to affect all parts of the public sector through the various initiatives mentioned above. 

Main points

Main objectives

It can be discussed whether the quality reform can be characterized as a reform in academic terms or whether it is more correctly characterized as a political strategy. Many of the initiatives are not described in much detail and implementation is rarely discussed at all. Only a few of the initiatives are directly related to the diminishing labour force. Buzz words like innovation, user involvement, open administration, increased productivity, efficient management and less bureaucracy dominate the reform strategy. 

The underlying motive of the Quality Reform is a diminishing labour force in combination with an expected increase in the demand for public welfare services. The argumentation is better quality for the same resources, meaning that new forms of administration have to be developed. 

Prior to the launch of the quality reform strategy, the government arranged five high profile meetings under the following headings:

1. Freedom of choice and personal responsibility
2. Coherent services
3. Measurement and responsibility
4. Innovation and competition
5. Management, involvement and motivation 

These themes are closely related to the traditional liberal-conservative coalition government core values, and in many respects the quality reform strategy is better perceived as a political policy program than an actual reform policy. 

The quality reform is divided into 8 sub-reforms focusing on the entire public sector: 

1. User centered welfare services
2. Attractive work places with focus on responsibility and professional development
3. Management and leadership reform
4. Local quality innovation
5. Increased focus on decentralised governing
6. Less bureaucracy
7. More staff for personal contact and care
8. Investments 

In addition to the 8 sub-reforms the quality reform also introduces a number of quality performance indicators for patients: 

• Acute treatment and information for patients with life-threatening cancer.
• Individual rooms for all patients for whom it is relevant and who request it.
• One assigned contact person for all hospitalized patients and for patients receiving continued outpatient care.
• Acute pre-hospital care within 15 minutes under normal circumstances. 

Type of incentives

The quality reform can be described as an overarching reform packet and does not yet in itself focus on specific types of incentives.

Groups affected

Citizens and patients, public sector work force

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral

The quality reform is still in the beginning of the political process and it therefore remains to be seen what the results of the initiative will be.

Political and economic background

The background of the quality reform was a situation of increasing pressure on the welfare agenda of the incumbent government. The opposition continuously criticised the government for not paying enough attention to the quality of the public welfare services and the government came up with the quality reform as a response. 

The economic background is a situation of demographic pressure with more people leaving the work force than entering. 

Change of government

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Origins of health policy idea

The initiator of the quality reform was the office of the Prime Minister, who established a ministerial group including six key ministers and their ministries (The Prime Minister's Office, the Ministry of Economic and Business Affairs, the Ministry of Finance, the Ministry of the Interior and Health, the Ministry of Social Affairs, and the Ministry of Family and Consumer Affairs). In the end of 2006 an expert group with 27 different participants was appointed by the government. In addition to this two personal representatives for the prime minister were appointed who visited a large number of public institutions in search for best practices in relation to quality improvement and increased job satisfaction. Five different thematic meetings were held as part of the process - all of them with key opinion leaders and led by the prime minister and/or other key ministers from the government.

Initiators of idea/main actors

• Parlament: The debate of the Danish Parliament shows that the opposition has pointed at the necessity of recruiting more labour force for the public sector by improving the working conditions, salaries and by introducing more local democracy

Approach of idea

The approach of the idea is described as:
new:

Innovation or pilot project

Else - The quality reform consists of 180 different initiatives, some of which have been developed and tested locally, while others are still on the idea level and/or in the initial development phase.

Stakeholder positions

The quality reform is more a concept than a concrete reform measure and it is difficult to be outright opposed to the intention of increased quality. The sheer magnitude of the quality reform also means that all stakeholders are pro at least one or more of the initiatives. Opposition will probably be more widespread when more of the political ideas materialize into concrete initiatives. 

The Red-Green Alliance is the only party that has left the political negotiation process at this stage. 

The intentions behind the quality reform have been accepted by all relevant actors and the initiative has so far succeeded in raising the concept of quality in the public welfare services on the agenda. However, the quality reform has not been as much of a driver in terms of agenda setting as the government had hoped. 

The Prime Minister and the government have held the leadership role in bringing forward the idea of a quality reform. Other main stakeholders have embraced the idea and participated actively in identifying possible initiatives for the reform package and in the debates on the quality strategy. 

Actors and positions

Parlament
Red-Green Alliance	sehr unterstützend		stark dagegen
The Social Democrats	sehr unterstützend		stark dagegen
The Social-Liberal Party	sehr unterstützend		stark dagegen
Danish-People's Party	sehr unterstützend		stark dagegen
The Socialist People's Party	sehr unterstützend		stark dagegen

Influences in policy making and legislation

Several of the initiatives from the quality reform will be discussed in parliament in the coming months and will most likely lead to legislation and step into effect in 2008. 

The exact power relations on the concrete and individual initiatives are not yet clear at the moment but will show in the coming political process. 

Legislative outcome

pending

Actors and influence

Parlament
Red-Green Alliance	sehr groß		kein
The Social Democrats	sehr groß		kein
The Social-Liberal Party	sehr groß		kein
Danish-People's Party	sehr groß		kein
The Socialist People's Party	sehr groß		kein

Positions and Influences at a glance

Adoption and implementation

If the intentions of the quality reform are to be realized all of the public sector and related stakeholders will be involved in the implementation. For this to be successfully realized the government needs to find continued support for the initiatives, especially among the major labor unions. The government moderates the political process, but as a minority government it needs to seek support from opposition and/or its support party. The government has so far been relatively successful in getting support from major stakeholders in the health care sector, including the labour unions and the associations of the regions and municipalities, who represent the decentralised levels of the Danish health care system. The actual implementation of the quality reform has not yet been discussed or drafted and it is thus too early to identify concrete obstacles. However, the implementation will undoubtedly be the determining factor for the success of the reform. 

Monitoring and evaluation

It is too early to say whether the resulting initiatives will include any mechanisms for monitoring and evaluation. It is, however, safe to say that it will be impossible to evaluate the whole quality reform as one initiative, since it consists of so many elements with many different objectives and incentives.

Results of evaluation

n/a

Expected outcome

The quality reform has so far gathered support from many key actors and since it is the major priority by the government it is likely to have significant effects. However, the underlying problems of decreased labour supply combined with an ageing population and increased expectations will not disappear. The quality reform consist of so many initiatives, most of which are still rather undefined, that it is impossible to foresee the exact effects on cost, quality and access/equity etc. 

Impact of this policy

Qualität	kaum Einfluss		starker Einfluss
Gerechtigkeit	System weniger gerecht		System gerechter
Kosteneffizienz	sehr gering		sehr hoch

References

Sources of Information

Web site on the Danish quality reform. www.kvalitetsreform.dk (in Danish only).

Author/s and/or contributors to this survey

Kjellberg, Jakob

Jakob Kjellberg is senior reseach associate at DSI, Danish Institute for Health Services Research.

Empfohlene Zitierweise für diesen Online-Artikel:

Kjellberg, Jakob. "The quality reform of the public sector". Health Policy Monitor, October 2007. Available at http://www.hpm.org/survey/dk/a10/2