Collective Competence as an Enabler for Service Integration in Health and Social Care Services.

Purpose: Fragmentation in health and social care services can result in poor access to services, lack of continuity and inadequate provision for needs. A focus on integration of services are thus suggested to prevent negative consequences of fragmentation for service recipients. There are, however, few studies that explore the competence needed for integration of services in municipal health and social care organizations. This study explores which types of competence stakeholders require and how collective competence can promote service integration. Methods: This is a single-case study, and the data consist of focus group interviews and individual interviews with service recipients, family caregivers, professionals and managers. The data were analysed both inductively and deductively. Results: The analysis resulted in four main themes: 1) Knowledge about individual life situations and organization and system, 2) investigation competence, 3) person-centred collaboration competence and 4) facilitating competence. The themes form the basis for a collective competence framework that can promote service integration. Conclusion: As service integration involves a high degree of interlinked activities between professionals and organizational units, a collective approach to the concept of competence is presumably applicable. When service integration competence is approached as a collective attribute of a network within and between organizational units, the organization can facilitate this competence by encouraging an active exchange of knowledge between professionals. We also argue that service integration competence increases connectivity and interdependency between professionals and organizational units, and includes service recipients and family caregivers as legitimate extra-professional parts of the collaborative network.

Do Shared Digital Workspaces Boost Integration? The Case of One Early Intervention Initiative for Vulnerable Children in Norway.

Introduction: The paper discusses the implementation of a digital workspace to facilitate collaboration in health and social services for vulnerable children and adolescents in eight Norwegian municipalities. The purpose of the workspace is to enhance collaboration independent of space and time. Collaborating services are schools, kindergartens, school health services, educational services and child welfare services. Methods: The data analysed are from semi-structured interviews with project leaders in primary care, responses of primary care professionals to open questions in a survey, and results from two questions in three subsequent surveys. Results: Project leaders held great expectations of increased collaboration. Variations were found regarding how far the implementation of a new workspace precluded previous methods of collaboration and whether retaining a familiar workspace necessitated strengthening resources to negotiate using the workspace. Organisational and professional cultures hindered the implementation of the workspace. Discussion: Interrelated barriers to collaboration were found at the professional, organisational and systemic levels. Some professionals could adapt the workspace to their existing tasks while others could not. Primary care providers need to strengthen their organisations while implementing the workspace. Conclusion: Concerted action at national and municipal level is needed to successfully implement digital tools.

Being bound and tied by the ropes of frugality: a case study on public management values and service integration.

PURPOSE: New Public Management (NPM) has increased fragmentation in municipal health and social care organizations. In response, post-NPM reforms aim to enhance integration through service integration. Integration of municipal services is important for people with complex health and social challenges, such as concurrent substance abuse and mental health problems. This article explores the conditions for service integration in municipal health and social services by studying how public management values influence organizational and financial structures and professional practices. DESIGN/METHODOLOGY/APPROACH: This is a case study with three Norwegian municipalities as case organizations. The study draws on observations of interprofessional and interagency meetings and in-depth interviews with professionals and managers. The empirical field is municipal services for people with concurrent substance abuse and mental health challenges. The data were analyzed both inductively and deductively. FINDINGS: The study reveals that opportunities to assess, allocate and deliver integrated services were limited due to organizational and financial structures as the most important aim was to meet the financial goals. The authors also find that economic and frugal values in NPM doctrines impede service integration. Municipalities with integrative values in organizational and financial structures and in professional approaches have greater opportunities to succeed in integrating services. ORIGINALITY/VALUE: Applying a public management value perspective, this study finds that the values on which organizational and financial structures and professional practices are based are decisive in enabling and constraining service integration.

Capacity to reduce inequities in health in Norwegian municipalities.

AIMS: One of the goals of the Norwegian Public Health Act is to reduce health inequities. The act mandates the implementation of policies and measures with municipalities and county municipalities to accomplish this goal. The article explores the prerequisites for municipal capacity to reduce health inequities and how the capacity is built and sustained. METHODS: The paper is a literature study of articles and reports using data from two surveys on the implementation of public health policies sent to all Norwegian municipalities: the first, a few months before the implementation of the Public Health Act in 2012; the second in 2014. RESULTS: Six dimensions are included in the capacity concept. Leadership and governance refers to the regulating tool of laws that frame the local implementation of public health policies. Municipalities implement inter-sectoral working groups and public health coordinators to coordinate their public health policies and measures. Financing of public health is fragmented. Possibilities for municipalities to enter into partnerships with county municipalities are not equally distributed. Owing to the organisational structures, municipalities largely define public health as health policy. Workforce and competence refers to the employment of public health coordinators, and knowledge development refers to the mandated production of health overviews in municipalities. CONCLUSIONS: The capacity to reduce health inequities varies among municipalities. However, if municipalities build on the prerequisites they control, establishing inter-sectoral working groups and employing public health coordinators in authoritative positions, national governance instruments and regional resources may sustain their capacity.