Equality in partnerships. The Coordination Reform in Norway

Abstract

Introduction: Norway introduced mandatory service agreements in 2012, as a reform instrument to strengthen partnerships between municipal care and hospitals. From the perspective of municipal care, lack of equality in these partnerships was prior to the reform perceived as an obstacle to collaboration. The study explores whether Norwegian municipalities perceive equality in these partnerships and improvement in collaboration, approximately 2 years after the reform was implemented.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. Then a national online survey was emitted to all 429 Norwegian municipals in 2013. The response rate was in total 58 percent (n=248). Mainly principal component analysis, ANOVA and descriptive methods have been applied.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. Norwegian municipalities perceive equality in relation to hospitals on these dimensions. Some improvement of collaboration outcomes was found. Discussion:Partnerships are usually based on voluntarism. The results indicate that statutory partnerships, within a public health care system, can be appropriate to equalize partnerships and improve collaboration between health care providers at different care levels.

Improving the Public–Public Partnership between a Rescue Department and an Integrated Social and Health Care Organization

“…Without supporting structures and jointly agreed-upon operating models, there is a risk that collaboration will become temporary and artificial. In accordance with previous research [12,13], our study shows that mutual trust, respect, and adequate knowledge of the other organization are fundamental cornerstones for a successful PuP.…”

“…We identified the need for effective governance models and defined 23.12.2022 FinJeHeW 2022;14(4) 400 structures around the partnership. Silo structures, a bureaucratic culture, size-power difference, lack of equality and mutual respect, and information and resource asymmetry are some of the reported challenges of public-sector partnerships [13,[17][18][19]. Thus, public-sector organizations must allow for change in organizational structures and cultures to enable successful collaboration.…”

“…Partnerships are based on trust and clear, compatible objectives and they strive for mutual benefit [11,12]. In the context of social and health care, partnerships are often formal and require a written agreement between the parties [13].…”

“…Public organizations are often arranged in silo structures and have a bureaucratic culture influenced by a top-down hierarchy, a core task, and defined roles [18]. The associated challenges in a collaborative relationship include, for instance, size-power difference, lack of equality and mutual respect, and information and resource asymmetry [13,17,19]. To ensure partnership success, trust, commitment, communication quality, joint planning, and joint problem resolution are factors that should be considered [12].…”