Entrepreneurial Actors between Two Systems of Norms: Profound and Professional Quality Knowledge in Swedish Health Care

In an imprecise sense, quality has always been an issue for health care and its actors. Quality issues are of great importance, since they intersect at the very core of a democratic health care delivery system, i.e. the authorities´ and the public´s demand for information confront the medical profession´s demand for self-regulation. The innovation of Swedish national quality registers contains important primary data that can play a significant role for control and improvement of health care. The medical profession started the first national register in 1975 for their opportunities of comparing methods of treatment. In the 1990s indicators generated from the national quality registers opened a new way for authorities to govern, control and improve knowledge about the quality in health care. Now, new demands are rising in a third practical application: public transparency, with a view to facilitate patient choice and improve quality of choices. A fundamental question is how the translation of primary data in national quality registers has been made feasible. Three puzzles are highly significant in this case; the medical profession´s degree of control over the information, the type of information that should be delivered to national and local authorities such as the National Board of Health and Welfare, Swedish Association of Local Authorities and the County Councils and to what extent the public should have access to the information. These puzzles are handled by entrepreneurs. They make the information in national quality registers comprehensible and manageable to initiate new ways of thinking, start new projects and take risks over time in the shaping of new institutional arrangements. Thus, the aim of this paper is to examine political entrepreneurship in order to understand how different actors use and translate information in quality registers.