Abstract
PurposeThe purpose of this paper is to increase the understanding of organizational challenges when decision-makers try to comply with technological developments and increasing demands for a more rational distribution of health care services. This paper explores two decision-making processes from 2007–2019 in the area of vascular surgery at a regional and a local level in Norway.Design/methodology/approachThe study draws upon extensive document analyses, semi-structured interviews and field conversations. The empirical material was analyzed in several steps through an inductive approach and described and explained through a theoretical framework based on rational choice (i.e. bounded rationality), political behavior and institutionalism. These perspectives were used in a complementary way.FindingsBoth decision-making processes were resource-intensive, long-lasting and produced few organizational changes for the provision of vascular services. Stakeholders at both levels outmaneuvered the health care planners, though by different means. Regionally, the decision-making ended up in a political process, while locally the decision-making proceeded as a strategic game between different departments and professional fields.Practical implicationsDecision-makers need to prepare thoroughly for convincing others of the benefits of new ways of organizing clinical care. By providing meaningful opportunities for public involvement, by identifying and anticipating political agendas and by building alliances between stakeholders with divergent values and aims decision-makers may extend the realm of feasible solutions.Originality/valueThis paper contributes to the understanding of why decision-making processes can be particularly challenging in a field characterized by rapid technological development, new treatment options and increasing demands for more rational distribution of services.
Highlights
Decision-making in health care on financing, provision and distribution of services is challenging with competing logics of managerialism, professionalism and “localism” (Garpenby and B€ackman, 2016; Choi et al, 2011; Magnussen et al, 2007)
The responsibility and ownership for the Norwegian hospitals were transferred from the counties to the central government through a system of 5, later 4 (2007) regional health authorities which again were divided into local health enterprises (Byrkjeflot and Neby, 2008; Grønlie, 2006)
Our study explores how decision-making processes unfolded in the area of vascular surgery at two levels of the health care sector
Summary
Decision-making in health care on financing, provision and distribution of services is challenging with competing logics of managerialism, professionalism and “localism” (Garpenby and B€ackman, 2016; Choi et al, 2011; Magnussen et al, 2007). The pressure to adapt to an increasingly disruptive new technology and its offerings combined with the financiers’ increasing inability to foot the growing health care bill, made non-incremental change “necessary” This change affected the interests of many important stakeholders, like groups of physicians, local communities and patients groups, often in a negative way. Physician resistance and growing interprofessional rivalries often undermined the ability of the new directors to manage professionally The results of these attempts to combine central control with local and to some extent health care professional autonomy were continued cost pressure, growing waiting lists and uneven quality. The hospital reform aimed to ensure that “independent” leaders could make the “right” decisions concerning the development of medicine, its accompanying technology, the official goals of cost efficiency, quality and equity (Pinheiro et al, 2017) This trade-off between political control and enterprise autonomy was challenging.
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