Ralf Kirchhoff

Aspects of Equality in Mandatory Partnerships – From the Perspective of Municipal Care in Norway

Introduction: This paper raises questions about equality in partnerships, since imbalance in partnerships may effect collaboration outcomes in integrated care. We address aspects of equality in mandatory, public-public partnerships, from the perspective of municipal care. We have developed a questionnaire wherein the Norwegian Coordination Reform is an illustrative example. The following research question is addressed: What equality dimensions are important for municipals related to mandatory partnerships with hospitals? Theory/methods: Since we did not find any instrument to measure equality in partnerships, an explorative design was chosen. The development of the instrument was based on the theory on partnership and knowledge about the field and context. A national online survey was emitted to all 429 Norwegian municipalities in 2013. The response rate was in total 58 percent (n = 248). The data were mainly analysed using Principal component analysis. Results: It seems that the two dimensions “learning and expertise equality” and “contractual equality” collects reliable and valid data to measure aspects of equality in partnerships. Discussion: Partnerships are usually based on voluntarism. The results indicate that mandatory partnerships, within a public health care system, can be appropriate to equalize partnerships between health care providers at different care levels.

Can we mandate partnership working? Top down meets bottom up in structural reforms in Scotland and Norway

Partnership working across health and social care is considered key to manage rising service demand whilst ensuring flexible and high-quality services. Evidence suggests that partnership working is a local concern and that wider structural context is important to sustain and direct local collaboration. “Top down” needs to create space for “bottom up” management of local contingency. Scotland and Norway have recently introduced “top down” structural reforms for mandatory partnerships. The purpose of this paper is to describe and compare these policies to consider the extent to which top-down approaches can facilitate effective partnerships that deliver on key goals.,The authors compare Scottish (2015) and Norwegian (2012) reforms against the evidence of partnership working. The authors foreground the extent to which organisation, finance and performance management create room for partnerships to work collaboratively and in new ways.,The two reforms are held in place by different health and social care organisation and governance arrangements. Room for manoeuvre at local levels has been jeopardised in both countries, but in different ways, mirroring existing structural challenges to partnership working. Known impact of the reforms hitherto suggests that the potential of partnerships to facilitate user-centred care may be compromised by an agenda of reducing pressure on hospital resources.,Large-scale reforms risk losing sight of user outcomes. Making room for collaboration between user and services in delivering desired outcomes at individual and local levels is an incremental way to join bottom up to top down in partnership policy, retaining the necessary flexibility and involving key constituencies along the way.

Model-driven Software Engineering in Practice: A Content Analysis Software for Health Reform Agreements

Abstract The Coordination Reform of 2012 requires Norwegian municipalities and regional health authorities to enter into legally binding service agreements. Although several research projects have been undertaken to analyse the implications of this reform, there is no central database where researches can be given access and analyse the service agreements. In this paper we present how we use model-driven software engineering and user-centric design in an initial development of an information system designed to allow researches to access and analyse service agreements. For this project, it was crucial to discuss the requirements of the system with domain-experts at a high level of abstraction in order to elicit feedback so that the development could proceed at a fast pace and in the right direction. Furthermore, given time and resource constraints, we elected to use a model driven approach using automatic code generation coupled with high-productivity frameworks. In this way we were able to create prototypes so that the developers could get fast feedback from the domain-experts and improvements could be implemented with minimal effort.