Roald Kvam 2024

A home is our castle and a base for unfolding our lives. In this house we should be able to live and live with security and well-being – and expect access to the help we need and the helpers we trust.

This is how I also think about a country’s total ecosystem for health and care services. It is our castle against external dangers and a catalyst for solutions and a catapult for unfolding lives.

I had an interesting talk with ChatGPT (3,5) about this, and this blog reflects this talk.

Welcome to «The Norwegian House», the ecosystem for Health and the Care system in my beloved home country.

Design

How is «The Norwegian House» organized? The Norwegian health and care system is organized to deliver services that promote the population’s health, provide medical treatment and care, and support the welfare of individuals. Here are some key features of the Norwegian health and care system:

Universal healthcare. Norway has a universal healthcare system, which means that all citizens have equal access to necessary healthcare services regardless of economic status. This is mainly administered through the public health system.

Delegation of responsibility. Responsibility for health and care services is shared between the state, counties and municipalities. The state has overall responsibility for health policy and legislation, while counties and municipalities are responsible for delivering services at a more local level.

Primary health care service. The primary health service constitutes the first line of health services and includes, among other things, GPs (NO: Fastleger), health nurses, physiotherapists and psychologists. The GP system is central, where all residents have the right to be associated with a GP.

Hospitals and specialist health services. The hospitals do the specialized health service and offer higher levels of diagnostics, treatment and care. The specialist health service is coordinated by regional health undertakings, and there are also private actors who perform specialized services.

Long-term and care services. Care services include nursing and care services for the elderly and people with disabilities. This may include home nursing, institutional care and measures to support independent living in one’s own home.

Patient rights. Patients have clear rights, including the right to choose their GP, the right to necessary health care, and the right to participate in their own treatment. The patient and user ombudsmen act as independent advisers for patients and users.

E-health and digitalisation. Norway has made significant progress in e-health, including electronic patient records, electronic prescriptions and digital solutions for patient communication.

Research and education. The Norwegian healthcare system is strongly linked to research and education. Universities and colleges play an important role in the education of healthcare personnel, and research is central to improving practice and developing new treatment methods.

Preventive health measures. Emphasis is also placed on preventive health measures to reduce the burden of disease. This includes campaigns to promote healthy lifestyles, vaccination programs, and early diagnosis of diseases.

For example, we can highlight the reform for independent living and the ability to live longer in one’s own home (NO: «Bo trygt hjemme»-reformen), which involves 6 governmental departments from 2023 to 2030. It becomes (decisively) important for us in view of the challenge of an aging population, combined with fewer professionals and tighter budgets. More on that later.

Social welfare system. The health and care system is integrated into the Norwegian welfare system, which also includes support schemes for unemployment, education, child benefit and other social services.

The Norwegian health and care system is characterized by a combination of public and private actors, with a strong focus on equal access to health services for all residents. It is also a constantly changing landscape, with continuous efforts to adapt to changes in the population’s needs, technology and societal conditions.

Improvement

How does «The Norwegian House» innovate? Innovation in the Norwegian health and care system is a central focus. Several initiatives and strategies have been implemented to promote innovation and improve the quality of healthcare. Here are some aspects of the status and position of innovation in the Norwegian health and care system:

E-health and digitalisation. Norway has made significant progress in e-health and digitalisation. Electronic patient records, electronic prescriptions, telemedicine and other digital solutions have been implemented to improve the availability, efficiency and safety of healthcare services.

National health and hospital plans. National health authorities regularly develop national health and hospital plans that include goals and strategies for innovation. These plans often focus on strengthening the primary healthcare service, promoting patient safety and quality in healthcare services.

Research and development. There is continuous research and development within the health and care sector in Norway. This includes studies to improve treatment methods, diagnostics, medical technology and the organization of health services is.

This last mentioned area here, the organization – and with it the interaction in “The Norwegian house” – I believe is an underestimated area of investment and improvement in view of the importance this has in order to have the better effect on the other mentioned areas.

Startups and innovation environments. There is increasing support and attention to health innovation from both the public and private sectors. Innovation environments and accelerator programs have been established for health and care start-up companies that work with innovative solutions.

Many good things have happened here in the last 10 years. And with Motitech, I have been closely involved in this part of the development of The Norwegian House. If I were to mention a shortcoming here, it would be that the innovative solutions also need new solutions for the implementation of innovations. Because there is no useful innovation until it is a used innovation…

Patient involvement. Innovation in the healthcare system also includes an increased focus on patient involvement. Patients’ experiences and feedback are becoming increasingly important in the design and evaluation of healthcare services.

The aim must be that we make no changes for the patient without the patient.

Innovators are well used to this: That we do not make any development steps in our products without involving the customers and end users – with this we ensure smart management of our time and resources; that we don’t burn resources on solutions that the customers/end users don’t want or need.

Interaction and interdisciplinary collaboration. It is a conscious effort to promote interaction and interdisciplinary cooperation in the health and care sector. This includes collaboration between the primary healthcare service, the specialist healthcare service and other actors to ensure holistic and coordinated services.

This is demanding. Not so much system-wise, but personnel-wise. Because the health and care sector is characterized by a high turnover, many measures that are set up for value creation in the medium and long term must nevertheless in practice be treated as fresh food…

Openness to international cooperation. Norway participates in international initiatives and collaborates with other countries to exchange best practice and benefit from international knowledge and experience in health innovation.

It is important to note that innovation in the health and care sector is an ongoing process. Innovation is necessary to meet challenges related to the aging population, technological advances and changing health needs, and it is expected that the Norwegian health and care system will continue to adapt and embrace innovative solutions.

Challenge

What barriers does «The Norwegian House» encounter during innovations? Although the Norwegian health and care system has made progress in innovation, there are also challenges and obstacles that can affect the implementation of new ideas and solutions. Some of the obstacles to innovation in the Norwegian health and care system include:

Fragmented structure. The system is organized with shared responsibility between the state, counties and municipalities. This can lead to fragmentation and a lack of a holistic approach, especially when it comes to the implementation of national innovation strategies.

Regulatory hurdles. Strict regulation and complex approval processes for new treatment methods, medical technology and drugs can be time-consuming and expensive. This can slow down the introduction of innovative solutions.

Prolonged decision-making processes. The decision-making processes in the Norwegian healthcare system can be time-consuming, and it can be challenging to get agreement and implementation across different levels of responsibility (state, counties, municipalities).

Culture and resistance to change. The health and care sector in Norway has what we may call a conservative culture. This is, in many ways, good. E.g. as it does not jump too quickly on the «latest news» and end up in quackery. But resistance to change and a conservative culture can also be obstacles to innovation. Health and care personnel may be (too) skeptical about implementing new methods and technologies.

Lack of interoperability. If different parts of the health and care system do not have compatible systems, it can lead to challenges with information sharing and collaboration, which is important for innovation.

Financial constraints. Limited resources and budget restrictions can limit investment in innovation. Prioritizing resources can also be challenging.

We know this will be more demanding for us in Norway in the future because we need to get to a level where we spend less money and fewer people per patient. Anything else is simply not sustainable in the long term.

Weak implementation structure. Although there may be innovative ideas, a lack of structure for implementation and follow-up can be a challenge. It requires robust implementation strategies to ensure that innovative solutions are integrated effectively.

Complex migration processes. The transition from traditional to innovative practices can be complex and face resistance. Training and support for healthcare personnel is necessary to ease the transition.

Ethical and privacy considerations. In the health and care sector, it is particularly important to assess and address ethical and privacy-related concerns related to new technologies and treatment methods.

Lack of interaction with research. It can be challenging to integrate new research and new technology into daily practice. A closer link between research environments and clinical practice can promote innovation.

Despite these challenges, the Norwegian health and care system works continuously to address obstacles and facilitate innovation through policy changes, cooperation with business, and increased attention to implementation strategies. A more holistic approach that takes into account both technological and organizational change, as well as a focus on building a culture that values innovation, can help overcome these obstacles.

Solidity

Does «The Norwegian House» have a solid design for a whole lifetime? Norway, like many other countries, is facing challenges linked to an aging population. Some call it even the “Silver Tsunami” or a “Wave of Elders”. The labels are not very useful, I think, but they reflect an increase in the number of older citizens who will need health and care services, as well as support to maintain a good quality of life. Here are some assessments of the Norwegian health and care system in relation to this “wave” of elderly people:

The primary health service and care for the elderly. The primary health service plays a key role in dealing with the wave of elderly people by offering preventive measures, care at home and coordinated health services. Elderly care includes services such as home nursing, home help, security alarms and provision of age-friendly housing.

Investment in health promotion and prevention. The Norwegian health and care system places increasing emphasis on health promotion and preventive measures to support the elderly in maintaining good health and independence. This includes measures such as physical activity, nutrition and social participation.

Investment in technological solutions. There has been increased interest in implementing technological solutions to support the elderly, such as telemedicine, welfare technology and digital health platforms. This can help to improve the availability of healthcare services and monitoring.

Home based care. There is a growing effort to strengthen home-based care for the elderly, so that they can live as long as possible in their own homes. This includes measures to adapt housing and provide necessary support services.

Nursing and nursing homes. Nursing homes play an important role in the care of elderly people who need more comprehensive support. There is an ongoing effort to improve the quality of institutional care and adapt services to the specific needs of older residents.

The patient’s rights and participation. The Norwegian healthcare system emphasizes patient rights, including the right of elderly patients to participate in decisions about their own health. This strengthens the patient’s autonomy and dignity.

Development of geriatric competence. There has been a growing recognition of the need for geriatric skills in the health and care sector to meet the complex needs of older people. This includes training of health personnel and specialized services for the elderly.

Community engagement. There is a growing awareness of the importance of community involvement and social participation for the elderly. This can help to counteract social isolation and strengthen mental health.

Research and innovation. Norway has active research environments that investigate challenges related to the aging population and seek innovative solutions. Research results are gradually implemented in practice to improve service quality.

Despite these positive aspects, the Norwegian health and care system also faces challenges. This includes the need for adequate funding, recruitment and training of health personnel, and adaptation to changes in demographics. The development of the elderly “wave” requires a holistic approach and continuous adaptation of health and care services to meet the growing needs of older citizens.

The Motiview-concept contains in a micro perspective several of the factors we need in a macro perspective to be successful in meeting the “wave” of older people. Read more about Motiview here: https://motiview.no/en.

Cohabitation

What is the relationship between the public and the private in «The Norwegian House»? In Norway, the relationship between public and private initiatives for innovation and health exports is complex and characterized by cooperation between sectors. Here are some aspects of this relationship:

Public funding of research and development. The Norwegian government provides significant support for research and development (NO: FoU) through public funds. This includes funding for health research, innovation in the health care system and the development of new medical technology. Public funds can therefore be catalysts for innovation in the health sector.

Cooperation with business. There is a strong focus on collaboration between public and private actors. This collaboration can be particularly prominent within health innovation and the development of new solutions. Many public research institutions, universities and hospitals actively collaborate with private companies and start-ups to promote innovation.

Public Procurement. Public procurement plays a role in stimulating innovation by encouraging private companies to develop and offer new solutions that can meet the needs of the health and care sector. This can lead to the development of innovative products and services.

Health clusters and innovation centres. There has been the establishment of health clusters and innovation centers that bring together public and private actors. These clusters act as platforms for collaboration, knowledge sharing and the development of innovative solutions.

Private initiatives and entrepreneurial activities. Norway has a growing sector for health and technology startups. Many private companies, including start-ups, are innovating in health. The government often supports private initiatives through various schemes and programmes.

Health exports. Norway has an increasing focus on health exports, where innovative solutions and health services developed locally can be exported to other countries. This may include the export of medical equipment, technological solutions and expertise within the health and care sector.

International cooperation. Public and private actors in Norway participate in international collaborative projects to promote innovation and health exports. This includes participation in EU-funded research projects and collaboration with other countries to exchange knowledge and experience.

Although cooperation between public and private actors is important, there can also be challenges related to co-creation, business models and adaptation of innovative solutions to a wider market. Balancing interests, building trust and establishing effective cooperation structures are therefore key aspects of the relationship between public and private initiatives for innovation and health exports in Norway.

Silos

Are there too many rooms in «The Norwegian House»? Management in a silo-based sector such as the health and care sector requires special attention to breaking down the silos and promoting cooperation and coordination between different units or departments. Silos refer to isolated areas of an organization where information, resources and decisions are not shared effectively across. Here are some strategies for leading in a silo-based sector:

Clear communication of goals and visions. Clear and distinct goals and visions must be communicated to all units in the organization. This helps to create a common purpose and provides direction for cooperation.

Foster a culture of collaboration. Managers must actively work to change the organizational culture and promote collaboration. This may involve rewarding cooperation and teamwork, as well as removing obstacles that limit information sharing.

Common meeting places and forums. Create regular meeting places and forums where representatives from different units can meet, exchange information and discuss common challenges. This can help build relationships across the silos.

Clear understanding of role. Ensure that all employees clearly understand their roles and responsibilities. This can help to avoid overlapping areas of responsibility and misunderstandings that can lead to silos.

Introduce common processes and tools. Implement common work processes and technological tools that facilitate collaboration and information sharing across units. This can help to standardize working methods and promote uniform practice.

Include silo-managers in decision-making processes. Involve managers from various units in strategic decision-making processes. This can help to ensure that decisions are well thought out and take into account perspectives from the whole organisation.

Establish common goals and KPIs. Identify common goals and key indicators (KPIs) that are relevant to the entire organization. This can help to focus efforts towards a common direction.

Collaborate on projects and initiatives. Encourage collaboration across silos by involving employees from different units in joint projects and initiatives. This can help build trust and mutual understanding.

Leadership training. Provide training in management and collaboration for managers at all levels. This can help them develop the skills and competencies necessary to lead in a silo-based sector.

If we want to have radical changes in the sector in the medium and long term, we must get a) innovation and b) implementation of innovation and c) public-private cooperation, d) user participation and e) management among silos on the agenda in education ASAP.

Evaluate and adjust continuously. Conduct regular evaluations to assess the effectiveness of the measures implemented to break down silos. Adjust the strategies based on feedback and experiences.

Management in a silo-based sector requires patience, commitment and a systematic approach. It is important to understand the specific challenges in the organization and adapt the strategies accordingly. Breaking down silos is a challenging ongoing process that requires sustained effort and follow-up. 

And listen: 

Research shows that without the leaders at the top of the silos actually cooperating, there is little or no structured and planned breakdown of the silos down the line. So, to all you top-leaders, lead the battle of the silos through lateral agility! Read more on lateral agility here: Hvordan leder på tvers av siloer?