Abstract
BackgroundIn Norway, a government reform has recently been introduced to enhance coordination between primary and secondary care. This paper examines the effects of two newly introduced measures to improve the coordination: an ICT-based communication tool/standard and an economic incentive scheme.MethodThis qualitative study is based primarily on 27 open-ended interviews. We interviewed nine employees at a hospital (the focal actor), 17 employees from seven different municipalities, and a representative of a Regional Health Authority.ResultsICT-based communication is perceived to facilitate information exchange between primary and secondary care, thus positively affecting coordination. However, the economic incentive scheme appears to have the opposite effect by creating tensions between the two organizations and accentuating power asymmetry in favor of secondary care.ConclusionsThe inter-organizational nature of coordination in health care makes it crucial for policymakers and management of care organizations to conceive incentives and instruments that work jointly across organizations rather than at only one of the health care organizations involved. Such an approach is likely to favor a more symmetrical pattern of collaboration between primary and secondary care.
Highlights
In Norway, a government reform has recently been introduced to enhance coordination between primary and secondary care
The economic incentive scheme appears to have the opposite effect by creating tensions between the two organizations and accentuating power asymmetry in favor of secondary care
We examine the case of Norway, as the Norwegian government, on January 1, 2012, has introduced a coordination reform to enhance care coordination and more efficient use of resources in the Norwegian health care system [37] designing instruments along the aforementioned lines
Summary
In Norway, a government reform has recently been introduced to enhance coordination between primary and secondary care. The tendency of health care organizations to work in ‘distinct silos’ [2] can be associated with different issues. It is related to existence of strong professional boundaries [3], which inhibit collaboration and knowledge sharing across boundaries [4]. As part of a care continuum, professionals in the two settings might compete for jurisdiction over certain tasks [5]. Jurisdiction, defined as the “the link between a profession and its work” [6], is crucial for professionals because it is their means of continued livelihood [7]. The unequal distribution of power among health care organizations is an obstacle to collaboration. Hospitals, providing most health care services and receiving most
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