Unsustainable projectification in public healthcare – short-term fixes to long-term challenges

Abstract

Organizing work as projects is a steady growing trend affecting all sectors of work, public healthcare included. Today, one-third of all work is project-based. Public healthcare faces acute problems like staff shortages, eroding trust in public institutions and scarce resources. Projects play an important role when counteracting these challenges, both because of the increasing projectification of the public sector, and because of project funding systems. Public healthcare is a bureaucratic sector with strong hierarchical structures being politically and administratively strictly regulated. Projects have become a symbol of adaptability and contingency, and a way out from bureaucratical organizational forms. Projectification is creating both intended and unintended consequences, which are not fully understood. This paper aims to identify, discuss, and evaluate the knowledge of projectification in public healthcare, something that haven’t been done before. The research questions are Q1: What have studies on projectification found as helpful in public healthcare? and Q2: What harmful consequences have projectification brought to public healthcare? The research method is a literature review, where articles are chosen based on database search and snowball method. Using a deductive content analysis, I present my results as categories of helpful and harmful effects on sectors, organizations, and individuals. Results show that projects are a flexible alternative of organizing work making developing, testing, and evaluating new ideas and work- methods easier. Projects work as an arena for collaboration and provides learning and work opportunities. However, projectification does not accelerate the creation of a sustainable, long- term solution to problems facing public healthcare. Projects are ready-made solutions searching for doable problems, working on the periphery of a healthcare sector rather than tackling the uncomfortable causes of the challenges. Knowing how projectification can be helpful or harmful allows policy makers, managers and project workers make the right decisions.