Development without Strategi - The Case of Web-based Health Care Services in Swedish County Councils

This article analyses the relationship between the development of web-based health care services and the strategies (formal and informal) which are supposed to guide their growth in the Swedish county councils (regions). The analysis is based on a mail questionnaire that was sent to and answered by all twenty-two county councils in the spring of 2004. The results show that all councils have a website on which they provide basic services, that about half of the councils provide advanced services and that all councils state that they are engaged in the development of novel services. About two thirds of the councils say that they do not have a formal strategy for the development of web-based health care services. The councils adopt an informal strategy when they rank the importance of various development ideals, but this strategy lacks credibility as it does not give priority to conflicting ideals. Because of the lack of strategy, insufficient integration of systems and coordination of activities have emerged as a major barrier to development and usage of e-services. In brief, the situation can be described as ‘development without strategy’.