Innovation in municipal home-based healthcare services

The current challenges facing municipal health and care services are exacerbated by increased demand and heightened expectations, alongside limited financial resources and difficulties in recruiting qualified personnel. Consequently, municipalities must develop solutions that optimize personnel resources, attract the necessary skilled labor, and create service offerings that align with societal expectations. The INCA project has addressed these issues by following, describing and analyzing innovation processes aimed at creating, developing, implementing, sustaining, and disseminating and translating new organizational models for home-based healthcare services in two municipalities. The project’s objectives have been to enhance understanding of innovation processes within Norwegian municipalities. We have explored the challenges and needs identified during the innovation efforts, as well as the resources required to address these challenges, to better understand how to bolster innovative capacity in Norwegian municipalities. A key focus of the project has been to apply the acquired knowledge throughout the process to support the innovation competence and capacity of the participating municipalities. This project has involved collaboration among researchers from NORCE (O. Øygarden, L.J. Gressgård, M. Nøkleberg, & T.N. Tørseth) and the Centre for Care Research West / HVL (A. Fagertun, C. Øye, F.F. Jakobsen, & I.J. Ramsøy), as well as Bergen and Bjørnafjorden municipalities. Through three case studies, we have examined all phases of the innovation process and the resulting outcomes. The findings from these case studies have been analyzed and compared, contributing to both theoretical development and knowledge exchange between researchers and practitioners. INCA has enhanced competence and provided new insights among managers and employees in the municipalities, leading to improvements in both the innovations developed by municipal partners and the processes for implementing these innovations. Examples of contributions to the innovations include improvements regarding team composition, interdisciplinary collaboration, increased awareness of the necessity for coordination across teams, and of new task division models that address the demands that task shifting puts on the work system. Regarding the implementation of innovation projects, INCA has generated new knowledge concerning the conditions, facilitators and barriers to success in administrative process innovations. Key barriers identified in our study include the challenging financial and personnel situation within the services, combined with the complexities of 24-hour operations, heavy workloads, shift work, geographically dispersed work, high levels of part-time and temporary staffing, significant sick leave absenteeism, personnel turnover, and unpredictable and shifting economic conditions involving sudden budget cuts. These factors complicate thorough innovation efforts and hinder the transfer and integration of new ideas, knowledge, and practices. Established norms in care work can both impede and facilitate innovation initiatives. Involving those responsible for implementing changes in the process and providing clear explanations of the changes fosters sustainable practice change at the operative level. Conversely, low levels of employee involvement, inconsistency in change efforts, and a lack of understanding regarding the rationale for changes can lead to a reliance on established norms, obstructing progress. Additionally, there is a notable overlap between innovation and cost savings projects, which may act as both obstacles and facilitators. Finally, we observe that ideas and key guidelines from national policy are translated to the municipal level through innovation projects in both municipalities. More broadly, INCA has facilitated knowledge transfer among (the participating) municipalities and fostered enhanced interaction, trust, and understanding between municipalities and research actors. The municipalities have indicated that the trailing research has provided reassurance in their innovation efforts and assessments, and contributed to the advancement of their projects by enhancing their visibility and momentum. They report a greater awareness of their own knowledge needs, recognizing that knowledge-based services require insights from research, and acknowledging the necessity to professionalize their engagement with research in their development initiatives. Trailing research has also contributed to documentation and continuity in processes, allowing municipalities to revisit and learn from previous experiences in their planning of further development activities, thereby strengthening their innovation capacity. Furthermore, INCA has generated value for other municipalities, the sector, and society through scientific publications and dissemination activities across various platforms.

INCA-prosjektet har bidratt til økt kompetanse og ny innsikt, med virkninger knyttet til forbedring av innovasjonene som ble utviklet av kommunene, og forbedring av gjennomføring av innovasjonsprosessene. Forbedringer av innovasjonene handler blant annet om sammensetning av team og forbedring av tverrfaglig samarbeid, kunnskap om betydningen av koordinering på tvers av team, samt kompetanse om hvordan hensiktsmessig oppgavedeling kan oppnås og hvordan dette stiller krav til arbeidssystemet oppgavene utføres innenfor. Når det gjelder gjennomføring av innovasjonsprosjekter har INCA produsert ny kunnskap om betingelser, drivere og barrierer for å lykkes med administrative prosessinnovasjoner. Sentrale barrierer identifisert i vår studie er den krevende økonomiske og personellmessige ressurssituasjonen tjenestene opplever, i kombinasjon med døgndrift, tidspress, turnusarbeid, geografisk distribuert arbeidsutførelse, høy deltidsandel og vikarbruk, høyt sykefravær, utskifting av personell, og skiftende økonomiske rammevilkår. Disse elementene vanskeliggjør grundig og godt innovasjonsarbeid, og overføring og oversettelse av nye ideer, ny kunnskap og nye praksiser som utvikles. Etablerte normer for omsorgsarbeid kan virke både som barrierer og drivere i innovasjonsarbeid. Dersom de som skal utføre endringene gjennom sitt arbeid blir involvert i prosessen, og endringene blir forklart og gir mening, legges det til rette for en varig endring av praksis. Når personell opplever lav grad av involvering, liten kontinuitet i endringsarbeidet og ikke helt forstår hvorfor endringer trengs søkes mening i etablerte normer og endring blir vanskeliggjort. Vi finner også høyt samsvar mellom innovasjons- og innsparingsprosjekter, noe som kan fungere som en barriere, men også en driver. Til slutt finner vi at ideer og sentrale føringer i nasjonal politikk blir overført og oversatt til det kommunale nivået gjennom innovasjonsprosjektene i begge kommuner. Mer overordnet har INCA bidratt til kunnskapsoverføring mellom (deltaker)kommunene, og til økt samhandling, tillit og forståelse mellom kommuner og forskningsmiljøer. Kommunene mener følgeforskningen har bidratt til trygghet i prosesser og vurderinger i innovasjonsarbeidet, og til fremdrift ved at arbeidet har fått tyngde, synlighet og moment. De forteller om økt forståelse for egne kunnskapsbehov, av at kunnskapsbaserte tjenester krever innsikt fra forskning, og for behov for å profesjonalisere seg i forhold til forskningsinvolvering i sine utviklingsprosjekter. Følgeforskning bidrar også til dokumentasjon av og hukommelse i arbeidet, og gir kommunene mulighet til å gå tilbake og lære av prosessene som har vært, og slik styrke sin innovasjonskapasitet. INCA har også gitt verdi til andre kommuner, sektoren og samfunnet gjennom formidlingsaktiviteter på en rekke ulike arenaer. En overordnet effekt er derfor at kommunale tjenester i fremtiden vil søke forskning for å utvikle kunnskapsbaserte og bærekraftige tjenester.

This project addresses the societal challenge of sustainable public healthcare service provision. It will follow and analyze the generation, development, implementation, sustainment, diffusion and translation of innovative organizational models for the delivery of municipal home-based healthcare services in two municipalities, as well as the (potential) realization of benefits from these innovations. It has been developed from a pre-project which analyzed the piloting of HELTOM, an innovative organizational model, in one home-based healthcare district Bergen. The piloting of is now complete. The model will be sustained in the piloting district, and implemented in the municipality’s remaining care districts. At the same time, neighboring Bjørnafjorden municipality is exploring the possibilities of implementing a similar model, inspired by HELTOM, but adjusted to the needs and characteristics of their specific municipal context. By analyzing these three, simultaneous processes – the sustainment of an innovative organizational model, the diffusion and adaption of the same model across different districts within the same large municipality, as well as diffusion to another smaller municipality – we will gain new knowledge on all three thematic sub-areas specified in the call for research on the theme of innovation in the municipal sector; innovation processes in municipalities, realization of innovations and benefits, and sharing of innovations. The project consists of four work packages. The overall method framework is a mixed method, longitudinal multiple case trailing design. In combination, three case studies cover all phases of the innovation cycle and the outcomes of innovation in terms of benefit realization, and case study findings will be subject to comparative analysis aiming for theory development and knowledge exchange between researchers and practitioners working on model development in the involved municipalities.