“It is a good idea, but…” A qualitative study of implementation of ‘Individual Plan’ in Norwegian mental health care

Abstract

The aim of the study is to explore and describe what hampers and promotes the implementation of 'Individual Plan'-Norway's answer to integrated care, and to discuss the findings according to implementation theory and research. 'Individual Plan' is a master-plan intended to increase user-participation and provide better coordination of measures for patients in need of extensive and long-term health-care services. Norwegian Health Authorities used a dissemination strategy to implement 'Individual Plan' but managers within health and social care could choose their own way of implementation in their organisation. Twenty-two managers from different clinics and organisational levels within mental health care were interviewed with an in-depth semi-structured interview about the implementation process in their organisation. The analysis was primarily made according to systematic text condensation. The findings describe different implementation processes and how the managers identified with the usefulness of 'Individual Plan' as a tool, choice of practical implementation strategies, the manager's own role, characteristics of organisational culture as well as how the manager considered external factors such as administration, lack of time and resources. The evolved implementation themes are discussed within a frame of existing knowledge and theory. A complex picture of barriers, dilemmas and benefits emerges, both internal and external to an organisation as well as at a personal level that need to be taken into consideration in forthcoming implementation processes to increase the rate of success.