Open comparisons results and costs SALAR

OPEN COMPARISONS:

Results and costs in Swedish local government

OPEN COMPARISONS:

Results and costs in Swedish local government

2 Results and costs in Swedish local government

Information concerning the content

Stefan Ackerby tel +46-8-452 77 28

Agneta Rönn tel +46-8-452 79 97

Swedish Association of Local Authorities and Regions

SE-118 82 Stockholm Visitors Hornsgatan 20

Phone +46-8-452 70 00 Fax +46-8-452 70 50

www.skl.se

© Sveriges Kommuner och Landsting

2nd edition, February 2012

Translation Semantix Equator AB

Graphic form and production Elisabet Jonsson

Cover photo Pia Nordlander

Typeface Georgia and Arial

Results and costs in Swedish local government 3

Preface

It is a challenge for every country to ensure that publicly-financed welfare meets high standards, fulfils citizens’ needs and is run efficiently.

In Sweden, municipalities and county councils have the main respon-sibility for health care, school and social care and various other public services run on a local level, with the local self government and power of taxation as their foundation.

One of the biggest successes for the Swedish Association of Local Au-thorities and Regions in recent years was the launch of Open Compari-sons. These allow transparent and easily accessible comparisons of results and associated costs of key areas presented by Sweden’s 290 municipali-ties and 20 county councils and regions.

Open Comparisons reveal how taxes are used and present the results achieved by municipalities or county councils in relation to others. The comparisons thereby act as a stimulus for improvement of operations and increased efficiency.

This document provides an explanation of Open Comparisons, how they have been developed and how they are used. The aim of the docu-ment is to spread knowledge and learning which will hopefully be of ben-efit beyond Sweden’s national borders.

Stockholm, November 2011

Håkan Sörman, Director General for the Swedish Association of Local Authorities and Regions

The Swedish Association of Local Authorities and Regions (SALAR) represents the go-

vernmental, professional and employer-related interests of Sweden’s 290 municipalities

and 20 county councils which include the regions of Gotland, Halland, Västra Götaland

and Skåne.


Contents

Background – Open Comparisons in a nutshell 5

Why Open Comparisons? 7

Open Comparisons and the Government 8

Open Comparisons – an investment for the future 9

How do the comparisons work? 9

Organization of the work with Open Comparisons 12

Analyses with Open Comparisons as the basis 12

Open Comparisons as the basis for improvements 13

Successes, challenges and continued development of Open Comparisons 17

The greatest successes with Open Comparisons 17

Challenges 17

Annex 19


Background – Open Comparisons in a nutshell

“Comparisons with other regions offer incredible poten-tial! Open Comparisons are excellent for municipalities and county councils. The principle of public access to offi-cial records and our similar assignments provide us with the opportunity to learn from one another. Everyone wants to do a good job and no-one wants to be at the bot-tom of the list.”

Håkan Sörman, Director General for the Swedish Association of Local Authorities and Regions

One of the biggest successes for the Swedish Association of Local Authori-ties and Regions (SALAR) in recent years has been the launch of Open Comparisons. These allow for transparent and easily accessible compari-sons of results from Sweden’s 290 municipalities and 21 county councils and regions1 within central areas such as medical care, elderly care and

school, as well as the cost of the activity. Open Comparisons have several purposes: • To show the citizens what they get for their taxes and the individual

municipality or county council’s standing in relation to others.

• To provide incentives for the municipalities and county councils’ ad-ministration as well as a tool for improving their activities.

• To present good examples from which others can learn.

1 A number of county councils have larger commissions and are known as regions. In this text, however, only the umbrella term 'county council' is used.



A few facts about the Swedish system

Open Comparisons are based on the Swedish social structure, in which municipalities and

county councils are responsible for the central welfare activities such as healthcare, school-

ing and social care within the scope of the local self government and power of taxation. The

Government’s responsibility concerns mainly regulation, monitoring and supervision,

whilst municipalities and county councils are responsible for financing and running the

activities in their own region or through another provider.

Open Comparisons also partly include activities run by contractors on behalf of the muni-

cipalities or county councils, e.g. within elderly care and primary health care. The compari-

sons concern primarily the combined activities of the municipalities and county councils,

not the activities of individual producers, but the concept is still developing and can in

principle apply to these as well.

The idea behind Open Comparisons is simple. In the comparison of re-sults and quality there is a pressure to produce more and better quality measurements as well as to conduct comparisons within more areas and between production units. The comparisons lead to analyses of why there are differences and why some municipalities or county councils are better than others. The results of the analyses can then be used for both local and national initiatives aimed at improving the activities in areas of defi-ciency.

Open Comparisons do not usually produce new data; they are a compi-lation of existing information in a new, easily accessible format. Open Comparisons present the value of each individual municipality and coun-ty council by means of a number of indicators. Examples of the indicators are ”the number of patients waiting more than 90 days for care”, ”the number of people satisfied with the treatment within the home help ser-vice for the elderly” and ”the number of pupils in the final year of compul-sory education who have passed every subject”. Open Comparisons there-by differ from traditional benchmarking, which focuses more on invested resources.

In order to be included in the report, the indicators must fulfil certain requirements: • The indicator must show results and performance within the different

activities, whereas measurements of structure and process-orientated measurements are used only if they have a clear link with the result. In the school environment, for example, the performance of pupils is compared, but not the pupil-teacher ratio.

• The indicator must reveal a clear trend – it should be possible to inter-pret a higher or lower value as a better or worse result. Municipalities and county councils can then be ranked in accordance with the results.

• It must be possible for municipality or county council to influence the outcome of the indicator.

• Data should exist for all municipalities or county councils.

• It should be possible to monitor the development of the indicated value over time.



In addition to the result indicators, information about the various costs of activities is also reported. Even if it is seldom possible to link the cost information directly to the outcome of individual indicators, it provides an understanding of the effectiveness, i.e., results achieved per invested kronor.

SALAR has been careful to point out that Open Comparisons are not intended to grade individual municipalities or county councils. The focal point is the improvements. By means of the comparisons, each munici-pality or county council can identify in which area its strongest and weak-est points lie, in comparison with others. Open Comparisons do not offer a joint assessment; each indicator is presented individually. Compulsory school is an exception, for which several indicators are jointly assessed.

Why Open Comparisons?

It is not obvious as to why an association like SALAR would openly com-pare its members in this way. As Open Comparisons include all con-cerned parties, both the best and the worst are presented. During the development of Open Comparisons, intensive discussions were conducted with regard to the negative connotations of ranking versus the positive points of making comparisons – where the fear of being ”hung out to dry” will eventually be overshadowed by the value and incentive of being able to openly present good or improved results. Open Comparisons have been well received by municipalities and county councils and provide good examples of how the activities can become more effective.

SALAR’s Director General, Håkan Sörman, explains why he has worked towards the launch of Open Comparisons:

”When I worked as City Director in Södertälje, I remarked on the big differences between the municipality’s schools. In discussions with each individual school, I received many explanations as to why the school in question was different to the others. There was no pressure to change. But when we openly presented the results for all schools, we had an entirely different and constructive discussion. There were, of course, natural explanations for the differences, but it was also clear that not everything could be explained away. This led to a more constructive outlook and insight; that everyone could learn from one another.”

In tax-funded activities, where there is often no marketing mechanism which can indicate whether or not the activities are effective, systematic comparisons can be a way of testing efficiency. In addition, the open pub-lication of comparisons also encourages a more factual debate and can contribute to bolstering the public’s confidence in the activities.

The primary target group for Open Comparisons is local politicians and officials at different levels, for example heads of operations. Other impor-tant target groups are the media, various organizations and citizens.



Part of the background to Open Comparisons is the increase in the in-terest for indicator-based comparisons over the past 10–20 years in many countries, for example the USA, England and Norway.

In Sweden there has long been a vast amount of data on health care and schools, which has not previously been used systematically or for follow-up and improvements. It was difficult for the uninitiated to gain access to data and make comparisons. At the same time, there are good conditions for the utilization of data thanks to the Swedish tradition of statutory registers and personal identity numbers which facilitate coordi-nation of information from different sources.

Through close cooperation between SALAR, county councils and the National Board of Health and Welfare, the first report of Open Compari-sons of the quality and efficiency of health care was released in 2006.

A successful introduction of the open comparisons for health care ser-vices in 2006 created good conditions for the continued development of the concept of Open Comparisons and a gradual expansion to include more municipal activities.

Open Comparisons are currently conducted in a number of fields of municipal activity: • Health care

• Compulsory school

• Upper-secondary school

• Elderly care

• Social services

• Public health

• Security and safety

• Local business climate

The Annex presents a list of the Open Comparisons published to date.

Open Comparisons and the Government

From the beginning, Open Comparisons have been conducted in collabo-ration with, or, in the case of schools with support from, the governmen-tal agencies active in each respective area.

Open Comparisons are promoted through the concerned governmental agencies’ interest and active contribution in the cooperation. It also sup-ports the authorities’ endeavours to improve result reporting based on the statutory requirements placed on the activities – even if this is not the primary driving force behind the comparisons.

There is moreover a keen interest in the central government for open comparisons, primarily within healthcare and social care. This has further contributed to the development. The Ministry of Health and Social Affairs has initiated a number of development programmes for Open Compari-sons within both health care and social services, and also assists with the financing of their associated development work.


Open Comparisons – an investment for the future

How do the comparisons work?

The work with Open Comparisons consists of a number of different parts, which are all of significance for the final result. It includes the development and choice of indicators, data collecting, compiling and presentation, analysis, marketing and obtaining of results as well as active improvements.

• Development and choice of indicators

A crucial part of the work consists of the choice of indicators which fulfil the requirements for inclusion in Open Comparisons. The indicators shall primarily show what the activities have achieved (result indicators) and the resources used (resource indicators). The big challenge is to find good result or ”output” indicators, which is significantly more difficult than finding indicators and measurements of ”input” and the activity’s struc-ture and process. Another important aspect is that the indicators must have clear and well-developed definitions.

The choice of indicators is influenced both by what data is available and the requirements stipulated for the indicators (see above). The condi-tions to form indicators can also differ considerably between different areas.

• Data collection

The idea is that there is to be no data collection specifically for Open Comparisons; they shall be based on existing information in the form of official statistics or other registers/equivalent which are subject to certain quality requirements, e.g. the national quality register for various medical specialities.

In practice, the lack of good results indicators has sometimes necessi-tated specific surveys or data collection for Open Comparisons in some areas. In this way, the work with Open Comparisons has also been able to take advantage of, and even stimulate, the ongoing development work in municipalities and county councils with the aim of producing new and improved indicators of results and quality.

Open Comparisons shall preferably include only indicators where the majority of municipalities and county councils can report values. In some



cases, indicators which hold values for a lesser share of municipalities or county councils have been included, due to the fact that they were consi-dered to be of interest and a possible source of inspiration for others. It is, however, common practice to require at least 30 observations in munici-palities before they can be included in the comparison, and correspon-dingly, observations for at least a third (i.e. 6–7) of county councils.

• Compilation and presentation

Each Open Comparison is presented in an individual report. The Open Comparison reports have a uniform structure and layout so that they are easily recognizable. For certain activities a report is produced an-nually, and for others this is done over longer intervals.

The report presents the values for the various indicators of results and resources for each municipality and county council. The municipalities and county councils are ranked according to their indicator values with the use of a special colour scale. The scale means that the municipalities in the top 25 per cent (with the ”best” values) are in the green band, those in the bottom 25 per cent are in the red and the middle 50 per cent are in the yellow. For county councils, the corresponding proportions are 33 – 33 – 33 per cent. This system has been chosen because it is simple and gives clear and strong signals, but it has been the subject of much discus-sion and has also received criticism.

The report contains an introduction in which the results are outlined and commented on. There are however no interpretations, conclusions or assessments. The idea is that municipalities and county councils use the results as the basis for their own analyses and continued change and de-velopment.

Open Comparisons are also presented on a number of websites – both as publications and results tables. Open Comparisons within social ser-vices are published solely on the Internet.

Facts on the Municipality and County Council Database – www.kolada.se

In collaboration with the Swedish Government, the Swedish Association of Local Authori-

ties and Regions runs the online database Kolada, with statistics and key facts and figures

for municipalities and county councils. The aim is to offer the possibility for comparisons

and analysis through providing a wide spread of information on activities and conditions in

municipalities and county councils. Thanks to Open Comparisons, Kolada now has key

facts and figures for quality and results for the majority of large-scale activities.

In Kolada, all Open Comparisons can easily be presented as completed reports. With a

flexible interface, the user can supplement reports with other national statistics, and make

comparisons with others.



Weighted results for pupils leaving compulsory school in 2010

• Marketing and reception of Open Comparisons

The work with conveying and marketing the results of Open Comparisons includes an ”acceptance and support phase” prior to publication in which municipalities and county councils have the opportunity to prepare for the receiving, and internal communication, of the results. Another impor-tant element is communication in relation to the media, in connection with the publication of the reports.

An important part of the work with Open Comparisons is to convey and create awareness of the results of the comparisons. The gaining of accep-tance and support for the results with the responsible municipality or county council is important in order for them to be prepared to explain why they look the way they do – whether the agency in question is at the top or the bottom of the list. The development has moved towards an increased acceptance of being subject to comparisons and trying to learn from and understand the results. Open Comparisons have had a huge



impact on, and have gained acceptance from, both politicians and man-agement.

There is a relatively large media interest in Open Comparisons. The ex-citement surrounding the first published report has gradually died down, but the reports still receive attention.

Organization of the work with Open Comparisons

The work with Open Comparisons is built on, and is run through, an ac-tive participation from municipalities and county councils. SALAR is re-sponsible for coordination and the concrete production of the reports within education, security and safety and the municipal business climate. The reports on social services and health care are developed in close co-operation with SALAR and the National Board of Health and Welfare.

For guidance and decisions with regard to the contents of the report, etc. a steering body consisting of representatives from management at SALAR, and in some cases concerned government agencies, is appointed. A working group, led by a project manager at SALAR and/or agency, is responsible for the actual work of developing and formulating the report – from the choice of indicators and production of tables and texts to the presentation of the report. The working group is assigned a group of con-tact persons (officials) from a number of municipalities and all 20 county councils. The group actively contributes to, and gives opinions on, the work in progress.

Open Comparisons are communicated and gain acceptance and sup-port throughout the process in an established networks of politicians, municipal officials and professional representatives.

Analyses with Open Comparisons as the basis

In order for Open Comparisons to be more effective as the basis for change and improvement, analyses of results are required, as well as ana-lyses of the factors that are associated with good results. Analyses con-ducted on a national level are reported. In addition, individual municipal-ities and county councils conduct their own analyses based on Open Comparisons.

A number of analyses have been conducted based on Open Compari-sons for health care with a few different methods. • A method study of the correlation between different indicators and

indices and a test of various explanatory models examined if, for exam-ple, there is a covariance between better medical results and lower costs, and whether or not opposition exists between high productivity and good medical results. The study was based on data from Open Comparisons for the period 2006–2008.

• Another study was aimed at presenting a method for developing indices in order to facilitate an overview of results from a number of different sub-areas. Indices have then, for example, been used in general discus-sions on the efficiency of health care in different county councils.



An analysis has been conducted based on Open Comparisons for compul-sory school of what characterizes a successful municipality with regard to schools. The study covered a number of municipalities with good results or with results which have improved over time. The study was conducted in the form of visits to various municipalities and interviews with a num-ber of municipal representatives. The study resulted in the identification of eight success factors: • Leadership characterized by responsibility, stability, clear role delega-

tion, trust, etc.

• Attention is drawn to competent teachers

• The expectations of the results are high

• Clear follow-up and feedback to the activities

• Work that contributes to functioning relations throughout the organi-zation

• Clear role and responsibility delegation between politicians, leading officials and headmasters

• Attend to pupils in need of special support

• Have a joint vision regarding the organization’s goals and direction

A similar analysis of success factors was made for Open Comparisons for elderly care based on in-depth interviews with representatives from 30 municipalities, half of which presented very good results; the other half somewhat less promising results. The following eight success factors for good elderly care were identified: • Care adapted to the individual

• Well-developed Human Relations strategy

• Executive management which is supported in the organization

• Clear role delegation between politicians and officials

• Systematic work with development of quality

• A user-orientated organization culture

• Structured cooperation with the county council

• Active cooperation within municipal networks

Open Comparisons as the basis for improvements

The conducted follow-ups have revealed that Open Comparisons are used by municipalities and county councils as a basis and tool for managerial functions in their management and quality work. Open Comparisons have also given rise to the need for national campaigns for improved results in schools and health care.

• Health care

In several follow-up studies, it has been ascertained that Open Compari-sons for health care have contributed to influencing the county councils’ governing processes by establishing and consolidating what has been



called ”a new way of thinking” within health care. This new way of think-ing entails that the governance shall be based, to an increasing degree, on measurements of results and that these measurements shall be open for observation and comparison. An important element is also that the go-vernance is broadened to include medical results. The pressure to expand the coverage of the report on medical results has increased, as has the pressure to improve the quality assurance of data. The influence on the county councils’ management culture has entailed a keener focus on er-rors in the system and an increase in public confidence in the organiza-tion as a result of a higher degree of openness and observation.

Based on Open Comparisons, the county councils and SALAR have since 2007 run a national campaign for increased patient safety with the aim of reducing care-related injury within health care through active pre-ventive work. The work has resulted in a clear decrease in care-related infections. The campaign has continued in its aim to also reduce medica-tion errors in handovers, injuries from falling and pressure sores.

Noscomial infections, 15–31 March 2010 and 2008–2010 Per cent of all patients in inpatient care



Comparisons reveal clear improvements in a number of areas between 2006 and 2010. A clear development is that the differences in quality between county councils have decreased for many indicators.

• Compulsory school

A series of interviews has been conducted in the municipalities on the use of Open Comparisons for compulsory school. The interviews revealed that they are used, inter alia, as the basis for prioritizations and analyses in-tended to identify areas for improvement and action. Open Comparisons have also contributed to an ”awakening” – some municipalities have re-ceived indications that the quality in schools is not as good as they had thought. The comparisons have also contributed to another debate on schools. Previously it was more a question of resources – now more focus is placed on the results and an increased awareness of the fact that these can be affected.

On a general level, conclusions and analyses of municipalities with good schooling results have been taken on board and used as a basis for the running of schools. A large number of municipalities now use the success factors detailed above as clear areas for development in their stra-tegic management of schools.

Based on the results of Open Comparisons, SALAR has also initiated a national campaign together with the municipalities which is aimed at improving mathematics teaching within compulsory schools. The target is for the pupils at this level in Sweden to be in the top ten for OECD 2015 – Sweden is currently in 20th place.

Proportion of girls and boys respectively that have received at least the grade Pass in the Mathematics’ test in 9th grade Per cent

• Elderly care

A series of interviews on the use of Open Comparisons for elderly care revealed that the reports are used as a means of prioritizing areas for development as well as prioritizing various measures within the budget. In addition, the results are used for making more in-depth analyses of weaknesses in order to be able to implement improvement measures. In general, it is ascertained that the comparisons received a great deal of interest as they had a high novelty value. Elderly care has traditionally not



been the subject of comparisons in the same way as schooling and health care.

Number of persons with fall injuries per 1,000 inhabitants aged 80 years or older and elderly who were hospitalized, per county. Average values for 2008–2010. Number of persons

With Open Comparisons as the foundations SALAR has, with financial aid from the government, begun national improvements in the form of a training programme targeted primarily at managerial functions within elderly care and social services, ”Managing for results”. The programme is an investment in higher standards, transparency and greater knowledge in order to meet the requirements of the commission given.


Successes, challenges and continued development of Open Comparisons

The greatest successes with Open Comparisons

• Municipalities and county councils have accepted and even favoured the concept of allowing their inclusion in open and systematic compari-sons where these are of value to citizens and users

• In some areas for open comparisons, especially in health care, the re-sults have improved and the differences between the county councils have been reduced.

• Open Comparisons have contributed to the debate on standards and efficiency within schooling, healthcare and social care.

• Open Comparisons have changed focus in the efforts to produce results

• Open Comparisons have contributed to analyses and improvements and therein to better operations

• Open Comparisons have encouraged the use of registers and statistics as well as the development of new results indicators

Challenges

The results of the comparisons vary greatly depending on the data/indi-cators used, or indeed a lack of data/indicators in a given area. The com-parisons paint a picture with what data is available, rather than the com-plete picture that we would like to see. In light of this, continued devel-opment of indicators and data is important. Improvement in the quality of data is also a pressing issue.

The simple classification of results with the use of a colour scale in Open Comparisons – red, yellow, green – has on occasions received criti-cism. For example, the classification shows only relative levels for each year, rather than absolute levels, which means that there could have been improvements across the board and the lowest quarter would still be ‘in the red’. The classification can also be criticized from the viewpoint of statistical methods.

Successes, challenges and continued developmment of Open Comparisons


Open Comparisons are a powerful instrument, though they also pre-suppose that the representation of reality is simplified, even if a great deal of care and effort goes into the choice of data and indicators. Background factors often exist which can explain the differences, but which are not immediately noticeable. There may be a risk that simple data is over-analyzed or that complex data is misconstrued, when in reality they should rather be seen as ”signals” which need to be analyzed and ex-plained in order for them to then lead to measures which improve opera-tions. This message must be constantly reiterated.

What have we learnt? How can Open Comparisons be deve-loped from here?

To be able to move forward and make use of the potential offered by the comparisons, SALAR has identified an important assignment in contri-buting to further development of methods and support for systematic analyses and improvements in county councils, regions and municipali-ties, as well as developing the governance and management based on the results of Open Comparisons.

On both national and local/regional levels, several in-depth analyses of the connections between good results and other factors must be con-ducted. Here, cooperation takes place between the municipalities, county councils and SALAR. The Government has also shown a strong interest in supporting the work. An analysis of the value of differences and differ-ences/variations as catalysts for change has begun.

A further development is being planned for IT-based presentation and analysis tools and IT-based tools for decision support.

Open Comparisons now include indicator values which are compiled for entire municipalities and county councils. Within the field of health care, the last few years have seen the presentation of a number of indica-tors for individual hospitals. Another area for development is the devel-opment of more indicators in Open Comparisons within both schooling and healthcare and social care, so that they can also be presented on a production unit level. The indicators shall be designed so that they can also provide a basis for information for decisions faced by individual citi-zens (choice of healthcare, school, etc.)


Annex

The appendix presents the different areas in which Open Comparisons have been published.

For each area, the number of conducted Open Comparisons is reported, as well as the number of indicators and main in-dicator areas.

Health care

Open Comparisons have been published annually from 2006 to 2011. Open Comparisons for health care 2011 includes 173 indicators per-

taining to medical results, accessibility, patient experiences and costs. The majority of the indicators are presented by medical field, e.g., wom-en’s health care, cardiac care, cancer care, psychiatry and medicine. 30 or so of these indicators relate to general health condition and mortality.

The reports compare the individual values of all county councils from the different indicators. The values are in most cases also represented separately for men and women. In addition to the values for all county councils from the different indicators, the change over time for individual indicators is also reported, as well as the comparisons between individual hospitals for certain indicators.

Elderly care

Reports have been published annually from 2007 to 2011. Open Comparisons 2010 includes a total of 30 indicators relating to

opinions of the elderly with regard to care, accessibility, preventive work, etc. In addition, a number of background variables are reported which can be of significance for the analysis of results. For 24 indicators, indi-vidual values for all municipalities are compared, whilst for the remaining six indicators only certain municipalities can report the value.

Compulsory school

Open Comparisons have been published annually from 2007 to 2011. Open Comparisons for compulsory school 2011 includes a total of 15

indicators relating to results, target achievement and merit rating. One of the indicators produces a value which is a combined assessment of sever-al other indicators’ values. Moreover, a number of background variables are also reported which can be important when analyzing results. For each indicator, the individual values for all municipalities are compared.

Annex


The 2011 report presents a more detailed review of the subject of ma-thematics.

Upper-secondary school

Reports have been published annually from 2008 to 2011. Open Comparisons 2011 includes a total of 39 indicators relating to re-

sults, completed studies, proportion of those commencing higher educa-tion, etc. In addition, a number of background variables are reported which can be of significance for the analysis of results. For each indicator, the individual values for all municipalities are compared.

Security and safety

Reports have been published annually from 2007 to 2011. Open Comparisons 2011 includes a total of 20 indicators relating to

personal injuries, fires, acts of violence, theft and perceived anxiety. For 16 indicators, the individual values for all municipalities are compared. For four indicators, only specific municipalities can report values. Of the 20 indicators, two are a combined assessment of a number of others.

Public health

A report was published in 2009. A new report is planned for 2013. Open Comparisons 2009 includes 21 indicators relating to living condi-

tions, lifestyle and effects on health. A number of background variables are also reported, which is of significance for the analysis of results. For different indicators, the individual values for municipalities and county councils are compared.

Social services

Open Comparisons within social services are made in collaboration with the National Board of Health and Welfare, which has the main responsi-bility for production and publication. These Open Comparisons are pub-lished solely online and not as written reports.

In 2011, Open Comparisons have been produced within the fields of health and social care for children and young people, addiction and de-pendency care, support for people with disabilities, and income support.

Local business climate

A report was published in 2011. Open Comparisons 2011 reports how companies perceive the munici-

palities’ exercise of public authority towards companies within a number of areas of authority, e.g., permission cases. Customer satisfaction was assessed through six quality indicators, including, information, accessibil-ity, legal rights and efficiency.

Reports translated into English

Health care 2007 and 2010 Security and safety 2010 Public health 2009 (summary)

Open Comparisons – Results and costs in Swedish local government

This document pro vides an explanation of Open Comparisons,how they have been developed and how they are used. The aim ofthe document is to spread knowledge and learning, which will ho-pefully be of benefit beyond Sweden’s national borders.

Download at www.skl.se/In English, Publications and reports.Price Free.ISBN 978-91-7164-686-xxx-x

Mail SE- 118 82 Stockholm Visitors Hornsgatan 20

Phone +46-8-452 70 00www.skl.se

Documents

Open comparisons results and costs SALAR