Care and welfare organizations and functions are constantly dealing with quality and development issues. Major efforts are also being made at national level to support continuous development work at local level. In recent years, regional structures have been initiated, to support evidence-based practice and increased cooperation in the welfare sector. Lately both financial and practical support from national level to the regions and municipalities of the country has been offered, to strengthen knowledge-based development of the welfare sector. The Flexit project "Cohesive Care and Welfare in a Sprawling Business Environment - Support Structures in Practice" was created at a time when national support was phased out and when the question of the prerequisites for quality support in the welfare sector was put to the forefront. FoU Välfärd (R & D Welfare), Västerbotten Region and the Epidemiology and Global Health Unit, Umeå University jointly created a platform for a Flexit project, which refined its title to "Support Structures in Practice - Knowledge Development, Development Work and Change in Local Care and Welfare."

FoU Välfärd was a strong player in the national policy "Better life for the most ill elderly". When this unit chose to invest in a Flexit project, this meant opening up for internal processes and access to its entire network for an action research project, involving requirements as well as opportunities for activity and change. The project has brought research knowledge on intermediate functions, but also initiated activities at regional and local levels participating in the project. During this research journey, many external conditions have changed, which put great demands on compliance for the regional support structure. Continuing change is one of the prerequisites that characterizes intermediate functions, and the Flexit project has monitored and contributed to the development process.

Research describes an increasingly complex reality where new knowledge and understanding of opportunities and conditions for quality and safety care and welfare involves increasing demands on managing the balance between financial control and quality of care, political decisions and patient benefit. External as well as the internal pressure on quality and development of care and welfare is increasing. The pursuit of the best possible scientific evidence and proven practice of care and welfare is as obvious as it has proved difficult to implement fully. Managing sustainable development in an ever-changing context poses major strategic demands, whether continuous improvement in daily work or major projects and policies. Applying a systemic view of development and change has proved difficult to achieve in practice, not least because system perspective involves necessarily taking into account people as well as their understanding, will and ability. Research on quality in care and welfare has an increasing interested in the processes and structures that form the engine for the quality development desired. Such research has long been in fields other than the medical research sphere. The need to elucidate these issues interdisciplinary is large but not simple because research traditions and research methods tend to crash more than interact. But the interest has aroused and every contribution that highlights the interplay between what you want to achieve and the conditions for how this can happen has a place in the international research arena.
The Flexit project has been about support structures at different levels, their goals and purpose, composition and function. One of the study objectives was to further develop the potential of regional and local support structures as supporte function for development and quality in care and welfare. Through an action research approach, the study has contributed to the development of support structures - concepts, functions and resources.

Three research questions have been present throughout the project: Support structures to strengthen knowledge transfer and development work - what is needed, who supports who and how does it work ?; How can local initiatives and knowledge from regional support structures and their own conditions and needs for knowledge transfer and development work be linked locally ?; How are people and patients and staff's perspectives and experiences taken into knowledge transfer and development work in care and care?
The project has conducted interviews and surveys involving regional and local actors. The project has participated actively in various networks and activities and since the research has been carried out with an action research approach, the project has participated in planning and monitoring activities and strategies to investigate, develop and follow up initiatives to strengthen the support structures' work. A special effort on systematic mapping dialogues for the entire region's social services was conducted. The project also actively participated in the development of structures for the local use of national quality records for development work, and in this context, the development of user dialogues was also investigated in the quality development process. During the project period, local functions were also explored, as constituting contact nodes between local and regional level. New strategies were developed in conjunction with the project and are still under development after the completion of the project.
In the Flexit project, three lessons have become extra clear; In order to provide a functional intermediary function, for example between local and national levels, continuous and close dialogue is needed with the context in which the support is to be implemented. Without such a dialogue, the risk of error or missed support increases the waste of resources and time for both intermediaries and actors. Surprisingly little knowledge and effort is found about strategic dialogue for collaboration. In a business context with considerably limited resources, it becomes particularly important to adjust support as needed, and to contribute to transfer between local and national level on needs and conditions when, for example, larger policies or projects that include performance benefits are initiated. The next lesson is about the importance of local capacity for development work to ensure that quality and development efforts are sustained and achieve the desired results. If local capacity to work with change and processes at management and / or business level is lacking, quality work is likely to be temporary bulb, which may reduce the conditions for future development work. And conversely, when investments in creating capacity to handle development is systematically and long-term, any new initiative or development seems easier to implement and the willingness to participate in new challenges seems to increase. The regional support structure's ability to contribute to the development of local support structures is long-term and strategic work at several levels. A third lesson is about the internal composition and strategic work of the intermediate function. To function in an intermediate role, a regional support structure needs to work dynamically because the intermediary's context is often variable with changing conditions and needs. Being in constant dialogue outward also requires continuous dialogue internally to keep the work together. A functional intermediate function needs to be skilled in communication and analysis to be able to detect needs, strengthen capacity, and increase the strength and value of networking.

Two new research questions were raised from the Flexit work, and both have resulted in new projects. Firstly, the question of special conditions for sparsely populated areas in fulfilling its welfare obligations, and how innovation can be a tool for development, addressing the major challenges that face these communities was highlighted. Second, large and growing expectations from national and local level are put  towards regional collaboration and support functions. What does the conditions really look like to be an intermediary function for the welfare sector at regional level when knowledge management becomes increasingly relevant and what does it mean in practice?

The question of intermediate functions is by no means isolated to the care and welfare sector or to Swedish conditions. In the field of public health as well as welfare, the role of being an intermediate function - an intermediary - between different organizational levels, such as local and national, is often discussed and very challenging. The value of finding strategies for this kind of features that can work in the tricky knowledge development field for health and welfare is high and demanded. The Flexit project has begun discussions with international researchers internally in the Epidemiology and Global Health Unit at Umeå University but also in Scotland. Here, the work continues after the end of the project with further discussions about the opportunity for research and development.
The project has been presented at several international conferences and more are planned. The project also held an appreciated think tank with participants from a bouquet of actors inside and outside the academy, where the opportunities and conditions of the knowledge creation chain were ventured eagerly, and unexpected contacts were knocked and new experiences and thoughts were exchanged.
Co-operation between FoU Välfärd, Region Västerbotten and Epidemiology and Global Health, Umeå University continues and is further strengthened, including new research projects. New research applications have also been created together with new actors at Umeå University.