Innovations on a shoestring: Consequences for job quality of public service innovations in health and social care

The article examines the innovation-job quality-employment nexus in social and health care in the United Kingdom and Sweden, respectively. Through seven case studies carried out with a common methodological and analytical framework in the two countries, it shows how the constraining factors of fiscal strictures derived from budgetary regimes and chronic labor shortages have two key consequences for innovation. The first is that in the absence of room for maneuver with regard to extrinsic job quality, intrinsic job quality becomes the primary innovation arena. Here the activation of feelings and ideologies of empathy towards patients and clients and occupational/professional pride are central. The second is that most of the innovations found aimed at addressing labor shortages are ameliorative rather than solutions, leading to the development of the concept of “coping innovations.” Both of these processes are symptomatic of “innovation on a shoestring” due to structural conditions. Certain, arguably beneficial, aspects of these constraints are identified, such as activities directed towards enhancing person-centered approaches to clients/patients and colleagues, less ‘technologization’ of care contact and opening up opportunities for non-traditional occupational and social groups in health and care work. Non-beneficial aspects of these constraints include heightened work intensity and employee turnover, an overtaxing of the Florence Nightingale ethos, and incomplete or unsatisfactory training and career development programs.