Abstract
BackgroundTraditional, hierarchical government structures have recently been challenged by increased complexity, fragmented services and heavy public demand. When healthcare services become fragmented and decentralised, they require redesign. Inter-municipal cooperation is a strategy to deal with current challenges and future demographic changes. Few studies exist that can help us conceptualize challenges regarding employment in this context and inform managers in the involved municipalities. This study aims to identify critical issues for employees in inter-municipal health care services and to elaborate on how and why these issues are experienced.MethodsA multiple qualitative case study was conducted with data from interviews, observation studies, a participant workshop and inter-municipal healthcare service project documents and reports. The study involved two districts in Norway and six cases including 17 informants. First, a within-case analysis was conducted for all cases; second, a cross-case analysis was conducted in each district to examine replication, contrasts and extension to emergent findings; and, eventually, replicated findings in Districts 1 and 2 were analysed across districts.ResultsThree critical issues were identified: support, differences, and geographical distances. Employees working in teams experienced fewer challenges than did those working as isolated individuals.ConclusionsCritical issues for employees represent an important aspect of inter-municipal cooperation, and additional research should be undertaken to inform future policy and practice.
Highlights
Traditional, hierarchical government structures have recently been challenged by increased complexity, fragmented services and heavy public demand
inter-municipal cooperation (IMC) organised at the level of individual employees involves more challenges than does IMC organised at the team level
Support Critical issues The findings suggest that support is a critical issue for inter-municipal employees
Summary
Traditional, hierarchical government structures have recently been challenged by increased complexity, fragmented services and heavy public demand. Traditional, hierarchical government structures have been challenged by increased complexity, fragmented services, heavy public demands and the need to reduce costs [1, 2]. Health care service delivery must be scaled to meet future needs, which will require changes that include service redesign and new structures for public service provision. In contrast to a traditional, hierarchically organised municipality, IMC often represents a less formalised and more loosely coupled system where control is distributed across several municipalities This might create challenges in coordinating management and control across municipalities in general and might create uncertainties for the employees in particular. To shed a light on the complexity of working in an inter-municipal healthcare service, two theoretical lenses are of particular relevance; Holen-Rabbersvik et al BMC Health Services Research (2018) 18:805
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