Health care professionals` experiences with the implementation of The Coordination Reform at a University Hospital in Norway - A qualitative study

Abstract

Introduction: The Coordination Reform was implemented January 1. 2012 in Norway with a changed distribution of tasks and responsibility between the primary health care and the specialist health care. For the specialist health care the aim was to concentrate to a greater extent on their specialized tasks. Aim: The aim of this study was to examine how health care professionals in a university hospital have experienced the implementation of the Coordination Reform. Method: Three focus group interviews and 3 individual interviews with nurses, doctors and leaders were conducted. Data was analyzed by using systematic text-condensation. Results: Lack of information within the hospital concerning the Coordination Reform made the informants feel unprepared for the changes that followed, especially in terms of the new guidelines for notifying the municipalities about patients in need of municipal follow-up after discharge. The informants experienced an increased focus on economy, because errors in the notification process led to less income for the hospital. The impression among the informants was that patients without complex care needs were faster received by the larger municipalities, unlike those with complex care needs. According to the informants this further affected their work in relation to use of resources. Conclusion: The aim for the specialist health care to focus more on their specialist competence and an improved coordination with the primary health care has not yet been achieved according to the informants in this study. They felt that different professional perspectives and lack of ICT-solutions were the biggest challenges in the coordination. Relevance: This study indicates that there is a further need for examining health care professionals in relation to the implementation of the Coordination Reform. One interesting aspect concerns the hospitals and specialization – More specialization or are they specialized enough: What is the right direction in terms of the patients and the health care professionals? Another aspect is the work with developing patient pathways and ICT-solutions - what are the effects on communication between the hospitals and the municipalities?