Digital Visions and Troublesome Realities in Health and Social Care Coordination in Norway

Abstract

A publicly provided health service, accessible to all, is a key aspect of the Nordic welfare state project, but questions around its sustainability have arisen in the face of increasing demands and limited resources. Current Norwegian policy concerns coordination (samhandling) between the specialist hospital sector and municipal health and social care in order to shift routine care out of hospitals and into municipal services. Despite coordination reforms, challenges remain, and Norwegian policy has centred on digital solutions to coordination. Questions remain as to whether the policy vision of digitalisation is compatible with the troublesome realities of coordination. This paper presents a case study of a digital platform for skills transfer from hospital to municipal health and social care in a Norwegian health region. It follows the platformʼs transformation from a marginal initiative lacking strategic endorsement to an acknowledged potential resource for health and social care coordination in the region. The paper asks how this transformation came about and what it can teach us about how to make digital technology work for coordination. The paper locates the transformation in how staff and managers engaged with each other and the platform to solve day-to-day coordination problems – many caused by existing digital coordination technology – and thereby adapted the platform to local challenges. The paper further argues that the management of digital coordination must give room for staff and managers to use their local experience to shape tools to local contingencies of coordination. Finally, the paper warns that the Norwegian policy for coordination and digitalisation poses a challenge to the room for manoeuvre at the local level.

Keywords

• Coordination
• health and social care
• learning platforms
• digitalisation