Micro practices of coordination based on complex adaptive systems: user needs and strategies for coordinating public health in Denmark

• Main Authors: Morten Deleuran Terkildsen, Inge Wittrup, Viola Burau
• Format: Article
• Language: English
• Published: Ubiquity Press 2015-09-01
• Series: International Journal of Integrated Care
• Subjects: user needs-based coordination; complex adaptive systems; micro practices; public health; anthropological qualitative approach; Denmark
• Online Access: http://www.ijic.org/articles/1530

<strong>Introduction: </strong>Many highly formalised approaches to coordination poorly fit public health and recent studies call for coordination based on complex adaptive systems. Our contribution is two-fold. Empirically, we focus on public health, and theoretically we build on the patient perspective and treat coordination as a process of contingent, two-level negotiations of user needs. <strong>Theory and Methods: </strong>The paper draws on the concept of user needs-based coordination and sees coordination as a process, whereby needs emerging from the life world of the user are made amenable to the health system through negotiations. The analysis is based on an explorative case study of a health promotion initiative in Denmark. It adopts an anthropological qualitative approach and uses a range of qualitative data. <strong>Results: </strong>The analysis identifies four strategies of coordination: the coordinator focusing on the individual user or on relations with other professionals; and the manager coaching the coordinator or providing structural support. Crucially, the coordination strategies by management remain weak as they do not directly relate to specific user needs. <strong>Discussion: </strong>In process of bottom-up negotiations user needs become blurred and this is especially a challenge for management. The study therefore calls for an increased focus on the level nature of negotiations to bridge the gap that currently weakens coordination strategies by management.