Conference article

Towards a Stakeholder Methodology - Experiences from Public Eldercare

Åsa Wreder
Division of Quality & Environmental Management Luleå University of Technology, Luleå, Sweden

Peter Johansson
Luleå University of Technology, Luleå, Sweden

Rickard Garvare
Luleå University of Technology, Luleå, Sweden

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Published in: 10th QMOD Conference. Quality Management and Organiqatinal Development. Our Dreams of Excellence; 18-20 June; 2007 in Helsingborg; Sweden

Linköping Electronic Conference Proceedings 26:15, p.

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Published: 2008-02-15


ISSN: 1650-3686 (print), 1650-3740 (online)


Most organisations need not only to satisfy its customers but also a number of other stakeholders and interested parties whose wants and expectations are often disparate; in conflict and subject to change. Donnelly (1999); among others discusses the complexity and further indicates a blurred view of customers and a variety of stakeholders to recognise in the public sector. The public eldercare in Sweden is no different. It is facing a rapidly increasing number of patients and also significantly stepped up demands and expectations from patients; relatives and the community; see Socialstyrelsen (2005); Hallin & Siverbo (2003) and Sinervo (2000).

The customer concept has been introduced in the health care sector as a replacement for ‘patients’; but it is still widely debated. Some critics argue that using the term customer decreases the importance of the individual person in care; whereas others think that customer implies that care is something that can be sold as any other product; see Keaney (1999). Indeed; Andersson (2004) claims that there are positive voices believing that the customer concept gives the patient more power and includes more actors than solely the patient; for instance; relatives and the society.

Over time the public eldercare has developed towards business organisations with a more apparent customer focus and increased demands on performance. Nurses in public eldercare have the highest medical profession and the uttermost responsibility; working under national legislation of health care operations. Thereby; the nurses have to fulfil both their obligations and answer to the demands of the patients as well as their relatives; see Johnsson (2000). This situation leads to conflicts where the satisfaction of one need or demand may be fulfilled on expenses of others (Brunsson; 2003). Adding to the problem is the fact that nurses often work alone in stressful situations where decisions and prioritizations have to be made under strong time pressure. Research also shows that many nurses in public health care often have a feeling of loneliness when making patient assessments and decisions about care and treatment; see Westlund & Larsson (2002). Unclear and contradictory pictures of the actual situation among different nurses and their managers are important problems in today’s public eldercare. There is a need for a methodology which could not only bring a uniform picture of the situation in terms of actual stakeholders; but also form a foundation for discussions regarding how to find a balance between conflicting stakeholder interests.

What originally started out as a desire to identify the stakeholders of Swedish public elder care later turned into the development of a tentative methodology for identification of individual stakeholders and stakeholder interests. The aim of this paper is to describe this development and the results and experiences gained during the process.


Elderly; patients; customer focus; stakeholders; health care; methodology


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