SustainGov is a mission-driven programme within Impact Innovation that is a joint effort of the Swedish Energy Agency, Formas and Vinnova. SustainGov's mission is to achieve a public sector that holistically promotes well-being for all residents, regardless of geography and socio-economic status, by 2035. The public sector must also ensure the sustainable transformation of society.
A reformed public sector with a systems approach
To achieve the program's mission, the public sector needs to fundamentally change. SustainGov advocates for a shift from today's reactive, organization-bound, and process-driven ways of working to more proactive, personalized, and impact-focused solutions.
The move involves many interacting changes in working methods, responsibilities and approaches within the public sector. The following starting points are central to SustainGov:
- Move from dealing with problems as they arise (symptoms) to preventing and anticipating them (causes). This enables a more sustainable and efficient use of shared resources.
- Move from an inside-out perspective to designing solutions that are based on the individual's needs and life situation. The individual and other actors should be given the opportunity to collaborate and take responsibility for joint solutions across organizational boundaries (outside-in perspective).
- Recognizing residents as active co-creators of solutions. By involving those who have first-hand experience of the challenges to be addressed, the public sector can develop more sustainable, relevant and effective interventions.
- Shift focus from being process-driven and only measuring short-term results with simple indicators to assessing long-term effects that contribute to societal development. Act based on a systems view and public accountability to ensure that no one falls through the cracks in the system.
- Ensure active involvement of, and shared responsibility between, multiple levels of government within the public sector to achieve increased systemic effects.
- Create new ways to engage equally and co-create solutions where the public sector, business, the nonprofit sector and individuals come together around common system challenges in aim to achieve the mission.
- Increase system capacity to develop, scale up, distribute and utilize new solutions.
- Act with strategic responsibility and active support from both political leadership and organizations to enable the desired transfers.
With these starting points, SustainGov intends to contribute to long-term shifts in how the public sector works, collaborates and creates value for society and its inhabitants. Fundamentally, it is about a reformed public sector with a systems perspective.
Program focus areas
SustainGov has chosen to focus its efforts on four focus areas:
- System-wide collaboration for complex care needs.
- An inclusive society for all.
- Future-proof food supply for health and well-being.
- The social contract of the future: a renewed relationship between residents and the public sector.
Focus area 1: System-wide collaboration in complex care needs
Swedish healthcare and social care are facing major challenges in meeting complex and future needs. Many municipalities assess that the current financing model is not sufficient to cope with elderly care and the healthcare ambition levels require annual efficiency improvements equivalent to several billion kronor to be maintained until 2040. At the same time, expectations from residents remain high, with eligibility requirements for the development of and access to new treatments and technologies.
One of the biggest problems is the lack of coordination and coordination, both within the health and medical services and between regions and municipalities, but also with state authorities and other actors. This leads to duplicated efforts, delays or, in the worst case, no care, quality deficiencies and insecurity for patients. Relatives often have to shoulder the responsibility for holding the efforts together, and for those without active relatives, access to high-quality care is made more difficult. The fragmentation of the health and social care system contributes to inequality, inefficient use of resources and increased costs.
Groups with large and complex care needs, such as the elderly with multiple illnesses, people with comorbidities and children with chronic diseases, are particularly affected. A small proportion of patients account for the majority of healthcare costs, but their needs are often handled by different actors without efficient collaboration. Fragmented care chains, strong financial management and different regulations make it difficult to find comprehensive solutions and contribute to individuals “falling through the cracks in the system”.
The public sector is expected to perform significantly more with fewer resources in the future, which requires new ways of working and better capacity for interaction between principals and other actors. Although preventive and coordinated efforts can reduce costs and improve results, incentives and joint governance to realize these are often lacking. Organizational and governance models focus largely on the organization or business itself in terms of both assignments, compensation and follow-up, which makes joint working methods difficult.
The problem, however, is not that there is a lack of collaboration forums between, for example, the region and municipality, but that these too rarely lead to concrete and lasting results for patients and residents. At the same time, in many cases there is a lack of working methods to support patients and residents' opportunities to contribute to their own health and well-being.
The challenge is to create a more person-centred and coordinated care system, where the actors work together to meet the needs of groups with the greatest need. If we fail to do this, it will be more difficult to ensure sufficient resources and capacity in welfare, and residents risk receiving lower quality care services, which can increase ill health and in turn undermine trust in welfare.
Focus area 2: An inclusive society for all
Sweden has a long tradition of striving for equality and social justice, but despite this, there are large groups in society that are at risk of being left out. Vulnerable groups, such as people with disabilities, people with low education, foreign-born people, young people at risk of exclusion or crime, and the elderly in involuntary loneliness, often face major obstacles to fully participating in society.
These barriers can be both structural and psychosocial. They can involve lack of access to education or other social interventions, difficulties in establishing themselves in the labour market, but also social norms and discrimination that make it difficult for people to feel part of society. At the same time, these groups often tend to be seen as passive recipients of support rather than active co-creators of solutions in their own lives, based on their own experiences and resources.
The challenges vary depending on the geographical and socio-economic context. In metropolitan areas, for example, residential segregation can affect opportunities for social cohesion, while some municipalities and rural areas may have difficulties in maintaining a wide range of welfare services. Differences in access to social services and opportunities for participation can thus affect social cohesion and lead to increased social disparities.
The public sector has failed to address recurring systematic causes of exclusion, such as lack of integration, discrimination or stigmatization. The tendency to focus on short-term solutions that do not address the underlying societal problems means that the effects of the interventions are too rarely sustainable in the long term.
The target group is individuals who face particular challenges in society and are at risk of social exclusion. This includes, for example, people with weaker socio-economic status, foreign-born people who face barriers to integration, or people with disabilities who may have limited access to support and fewer opportunities to participate fully in society.
Many in these groups are affected by factors such as interrupted schooling, unemployment, health problems or lack of social networks, which can make it difficult for them to participate fully in society. Organized crime and discrimination pose additional risks. At the same time, shortcomings in support- and social systems can make it more difficult to get the right help in a timely manner. By strengthening these groups and creating better conditions for inclusion, interventions can contribute to a more equal and cohesive society.
Focus area 3: Future-proofing food supply for health and well-being
The food supply in Sweden faces major challenges that affect both individuals and society. With a low degree of self-sufficiency and a strong dependence on imported inputs, our food system is vulnerable, especially in times of crisis or disruption in global supply chains. In addition, unhealthy eating habits have an impact on public health, leading to an increasing incidence of diseases such as obesity, diabetes or cardiovascular diseases. This affects both health of the individual and the burden of care that must be managed by the public health and medical services.
The lack of a systems approach makes it difficult to work towards a sustainable food supply. Public responsibility for food supply is often fragmented, with responsibility for planning, implementation and supervision divided between different sectors and levels within the public sector. Lack of coordination between these actors leads to ineffective solutions and makes it more difficult to manage the complex conflicts of interest that exist between the environment, food production and public health. This also makes it more difficult to implement long-term solutions, which means that short-term problems receive more focus than long-term societal challenges.
A clear example of systemic problems is that farmers often find the administrative regulations supported by many authorities burdensome, which can lead to stress, affect their quality of life and, in the long term, impair the capacity to deliver high-quality domestic raw materials. At the same time, agriculture has an important role to play in climate change adaptation, society's resilience to crises and wars, and access to sustainable, healthy and locally produced food.
To create a future-proof food supply for health and well-being, the public sector needs to work in new ways together with other actors. A new way of working that not only prioritizes the production of and access to food but also promotes health and sustainability. This means that healthy food must be both accessible and affordable for everyone, regardless of socio-economic background, while production must reduce its environmental impact and become more resilient to future crises.
Focus area 4: The social contract of the future – renewed relationship between residents and the public sector
SustainGov's fourth focus area differs from the other three. It is of a more generic nature and has relevance to many different policy areas. Here, the focus is on rethinking established approaches, norms and structures that hold back the development of the public sector.
SustainGov's mission stems from a need to renew and future-proof the so-called social contract between citizens and the public sector. The conditions for maintaining today's public services are not sustainable in the long term, whether in terms of available resources or the expectations that citizens have.
There is a growing perception among certain groups in society that parts of the public sector are abdicating their responsibilities and that the needs of residents are not being met. This leads to reduced trust in public institutions. Many residents also feel invisible and experience a gap between expectations and the actual outcome of public services. At the same time, business and civil society experience that they are not included as equal actors in social development, even though they often have solutions and ideas.
To meet this challenge, a shared vision of responsibility and mission is required, where the public sector joins hands with citizens, business and civil society. This requires a change in how the public sector is governed and led to create more needs-oriented and inclusive systems. By working together and learning from each other, we accelerate the paradigm shift towards new ways of working in the public sector that are better positioned to achieve the SustainGov mission than today's systems.
A key aspect is to redefine the view of one's own role; traditionally, public organizations have shown too much interest in themselves and their own operations. By allowing the user to take a greater place in the interpretation of what constitutes a well-functioning activities, pressure is created for change. This means redefining the role of the public sector. The public sector is not only a democratic actor, community builder and service provider, but also an active co-creator of solutions together with residents, business and civil society. By promoting interaction and trust between all societal actors, we can build a more efficient and sustainable public sector where the needs and values of residents are at the center.
Today, it is the public organization and its service production, or parts of it, that are controlled and monitored, rather than the effects that public sector deliveries have on residents, patients, users or companies. To better meet the needs of society, public resources and governance must be focused on functions that create real benefit, rather than maintaining organizational structures that do the right thing based on their missions but at the same time have limited effect on the individual and/or societal level.
Governance and organizational models within the public sector therefore need to be developed to focus more on long-term consequences and effects, while at the same time providing better conditions for broad collaboration across organizational boundaries.
This also requires increased understanding and acceptance that actors other than the public sector can themselves contribute to more effective and value-creating interventions. Today, there is a widespread perception that preventive and promotional interventions are important, but in practice, short-term solutions and emergency interventions are often prioritized.
To change this, multi-year budgets and operational plans could be a possible way to try. Impact measurements, socio-economic calculations and outcome contracts are other examples of such tools that fall within this focus area. There is also a need to address the investment paradox, where many valuable ideas are never implemented because the actors who bear the cost cannot absorb the benefits.
SustainGov can also be seen as an effort to strengthen democracy. This requires a shared view of responsibility and mission, where the public sector more clearly links arms with residents, business and civil society. Sweden lags behind many countries when it comes to increasing citizen engagement and influence in democratic and political processes. The initiatives that are implemented often lack political anchoring and representative participation. They are implemented as isolated efforts and therefore do not affect the system at large. Here, efforts are needed at several levels that enable actual participation supported by new processes, tools (not least digital), and ways of organizing to strengthen participation and participatory democracy.
More information about SustainGov
For further information about SustainGov and the efforts the program is implementing to achieve systemic changes in the public sector, see SustainGov's website.
More information about Impact innovation
Impact Innovation is Sweden's major innovation initiative to tackle the challenges of our time and the future. In collaborations between actors in the private, public and non-profit organizations, Impact Innovation meets real technical and societal needs with groundbreaking solutions. On the way to a sustainable and competitive Sweden, attractive to live in for everyone. Together we show what is possible, and are ahead internationally.
Impact Innovation works with new methods, approaches and tools to meet societal needs with groundbreaking solutions. More information about mission-oriented working methods and concepts such as systems innovation can be found at Impact Campus.