Team Effectiveness in General Practice: Insights from the Norwegian Primary Healthcare Team Pilot

This chapter provides insights into team effectiveness in general practice. It is based on a qualitative case study from five purposively recruited Norwegian general practices participating in a pilot for implementing primary healthcare teams. To assess team effectiveness, 41 individual and group interviews were performed in the practices. The data production and the analysis were guided by Hackman’s team effectiveness model. Five overarching themes were identified: teamwork nature, buy-in, macro-team leadership, individual satisfaction, and performance outcome. Despite variation in the organizational context, the informants at four of five of the practices agreed that functional teamwork produced good and relevant results—primarily for the patients, as well as largely for themselves as it increased job satisfaction. The study shows that becoming real and effective micro- or macro-teams involves extensive, targeted, and time-consuming change work. Actual change requires leadership, buy-in, and a significant effort linked to structuring the teamwork. The results raise the question of whether it is a sensible use of resources to scale up and spread primary healthcare teams to all general practices in Norway. Management training as part of specialist training for all general practitioners to acquire the competence to lead effective micro-teams could be beneficial for teamwork development

Recruit & Retain - Making it Work. Den norske case-studien

Also available at https://www.nsdm.no/wp-content/uploads/2019/01/NSDM-rapport-Recruit-Retain-Making-it-Work-Den-norske-case-studien.pdf. Denne rapporten er skrevet som del av sluttrapporteringen av prosjektet Recruit & Retain – Making it Work. Prosjektet er støttet av EU-programmet The Northern Perifery and Arctic Program (http://www.interreg-npa.eu) og har gått over tre år fra februar 2016 til januar 2019. Hovedmålsettingen med prosjektet har vært å finne fram til modeller for å arbeide systematisk med rekruttering og stabilisering av nøkkelpersonell til velferdstjenester i distrikt. Det enkelte land har gjennomført sine egne delprosjekt. NSDM har i sitt delprosjekt jobbet med Meløy, Odda og Årdal, tre kommuner som over tid har hatt store rekrutterings- og stabiliseringsutfordringer i sin fastlegetjeneste, med mål om å bedre situasjonen. De øvrige partnerne i prosjektet har gjennomført liknende delprosjekt i sine land. Denne rapporten er skrevet med utgangspunkt i NSDMs perspektiv på prosjektet og gjennomføringen av det. Den norske case-studien i EU-prosjektet Recruit & Retain – Making it Work har hatt mål om å bidra til: 1) å forbedre rekruttering og stabilitet av fastleger i tre case-kommuner, 2) identifisere vellykkede strategier for rekruttering og stabilisering og 3) formidle disse strategiene til andre liknende kommuner

Styringsutfordringer i ny søknadsbasert turnusordning

Source at https://www.utposten.no/i/2017/5/utposten-5-2017b-764.Geografisk fordeling av leger er ett av målene med turnusordningen. Formålet med denne artikkelen er å peke på noen styringsutfordringer i den nye søknadsbaserte turnusordningen sett i lys av dette målet. De handler blant annet om selektiv oppmerksomhet fra helsemyndighetens side og mangler i samstyringen mellom helseforetak og kommuner

Tension between local, regional and national levels in Norway’s handling of COVID-19

Aims: This study aimed to explore the tension between local, regional, and national authorities evoked by some rural municipalities’ decisions to impose local infection-control measures during the first weeks of the COVID-19 pandemic in Norway. Methods: Eight municipal Chief Medical Officers of Health (CMOs) participated in semi-structured interviews, and six crisis management teams participated in focus-group interviews. Data were analysed with systematic text condensation. Boin and Bynander’s interpretation of crisis management and coordination and Nesheim et al.’s framework for nonhierarchical coordination in the state sector inspired the analysis. Results: Uncertainty in the face of a pandemic with unknown damage potential, lack of infection-control equipment, patient transport challenges, vulnerable staff situation and planning of local COVID-19 beds were some of the reasons for rural municipalities imposing local infection-control measures the first weeks of the pandemic. Local CMOs’ engagement, visibility and knowledge contributed to trust and safety. Differences in perspectives between local, regional and national actors created tension. Existing roles and structures were adjusted, and new informal networks arose. Conclusions: Strong municipal responsibility in Norway and the quite unique arrangement with local CMOs in every municipality with the legal right to decide temporary local infection-control measures seemed to facilitate a balance between top-down and bottom-up decision making. Tension between rural, regional and national actors that arose due to local infection-control measures, and the following dialogue and mutual adjustment of perspectives, led to a fruitful balance between national and local measures in Norway’s handling of the COVID-19 pandemic

Inequality of opportunity in a land of equal opportunities: The impact of parents' health and wealth on their offspring's quality of life in Norway

Background: The literature on Inequality of opportunity (IOp) in health distinguishes between circumstances that lie outside of own control vs. eforts that – to varying extents – are within one’s control. From the perspective of IOp, this paper aims to explain variations in individuals’ health-related quality of life (HRQoL) by focusing on two separate sets of variables that clearly lie outside of own control: Parents’ health is measured by their experience of somatic diseases, psychological problems and any substance abuse, while parents’ wealth is indicated by childhood fnancial conditions (CFC). We further include own educational attainment which may represent a circumstance, or an efort, and examine associations of IOp for diferent health outcomes. HRQoL are measured by EQ-5D-5L utility scores, as well as the probability of reporting limitations on specifc HRQoL-dimensions (mobility, self-care, usual-activities, pain & discomfort, and anxiety and depression). Method: We use unique survey data (N=20,150) from the egalitarian country of Norway to investigate if diferences in circumstances produce unfair inequalities in health. We estimate cross-sectional regression models which include age and sex as covariates. We estimate two model specifcations. The frst represents a narrow IOp by estimating the contributions of parents’ health and wealth on HRQoL, while the second includes own education and thus represents a broader IOp, alternatively it provides a comparison of the relative contributions of an efort variable and the two sets of circumstance variables. Results: We fnd strong associations between the circumstance variables and HRQoL. A more detailed examination showed particularly strong associations between parental psychological problems and respondents’ anxiety and depression. Our Shapley decomposition analysis suggests that parents’ health and wealth are each as important as own educational attainment for explaining inequalities in adult HRQoL. Conclusion: We provide evidence for the presence of the lasting efect of early life circumstances on adult health that persists even in one of the most egalitarian countries in the world. This suggests that there may be an upper limit to how much a generous welfare state can contribute to equal opportunities

Clarifying Associations between Childhood Adversity, Social Support, Behavioral Factors, and Mental Health, Health, and Well-Being in Adulthood: A Population-Based Study

Publisher's version, source: http://10.3389/fpsyg.2016.00727.Previous studies have shown that socio-demographic factors, childhood socioeconomic status (CSES), childhood traumatic experiences (CTEs), social support and behavioral factors are associated with health and well-being in adulthood. However, the relative importance of these factors for mental health, health, and well-being has not been studied. Moreover, the mechanisms by which CTEs affect mental health, health, and well-being in adulthood are not clear. Using data from a representative sample (n = 12,981) of the adult population in Tromsø, Norway, this study examines (i) the relative contribution of structural conditions (gender, age, CSES, psychological abuse, physical abuse, and substance abuse distress) to social support and behavioral factors in adulthood; (ii) the relative contribution of socio-demographic factors, CSES, CTEs, social support, and behavioral factors to three multi-item instruments of mental health (SCL-10), health (EQ-5D), and subjective well-being (SWLS) in adulthood; (iii) the impact of CTEs on mental health, health, and well-being in adulthood, and; (iv) the mediating role of adult social support and behavioral factors in these associations. Instrumental support (24.16%, p < 0.001) explained most of the variation in mental health, while gender (21.32%, p < 0.001) explained most of the variation in health, and emotional support (23.34%, p < 0.001) explained most of the variation in well-being. Psychological abuse was relatively more important for mental health (12.13%), health (7.01%), and well-being (9.09%), as compared to physical abuse, and substance abuse distress. The subjective assessment of childhood financial conditions was relatively more important for mental health (6.02%), health (10.60%), and well-being (20.60%), as compared to mother's and father's education. CTEs were relatively more important for mental health, while, CSES was relatively more important for health and well-being. Respondents exposed to all three types of CTEs had a more than two-fold increased risk of being mentally unhealthy (RRTotal Effect = 2.75, 95% CI: 2.19–3.10), an 89% increased risk of being unhealthy (RRTotal Effect = 1.89, 95% CI: 1.47–1.99), and a 42% increased risk of having a low level of well-being in adulthood (RRTotal Effect = 1.42, 95% CI: 1.29–1.52). Social support and behavioral factors mediate 11–18% (p < 0.01) of these effects. The study advances the theoretical understanding of how CTEs influence adult mental health, health, and well-being

Educational interventions to ensure provision of doctors in rural areas - a systematic review

Introduction: Recruiting doctors in rural areas is challenging. Various educational interventions have been introduced in many countries. This study aimed to explore undergraduate medical education interventions introduced to recruit doctors to rural areas, and the results of these interventions. Methods: We undertook a systematic search using search words 'rural', 'remote', 'workforce', 'physicians', 'recruitment' and 'retention'. We included articles meeting the following criteria: educational interventions clearly described; study population consisted of medical graduates; and outcome measures included place of work (rural/non-rural) after graduation. Results: The analysis included 58 articles and encompassed educational interventions in ten countries. There were five main types of interventions, often used in combination: preferential admission from rural areas; curriculum relevant to rural medicine; decentralised education; practice-oriented learning in rural areas; and compulsory service periods in rural areas after graduation. The majority of the studies (42) compared place of work (rural/non-rural) of doctors graduated with and without these interventions. In 26 studies, odds ratio for rural place of work was significant at a level of 5%, with odds ratios between 1.5 and 17.2. Significant differences in the proportion with a rural/non-rural place of work were shown in 14 studies, differences ranging from 11 to 55 percentage points. Discussion: Changing focus of undergraduate medical education towards development of knowledge, skills and teaching arenas that equip doctors with competencies to work in rural areas has an impact on the recruitment of doctors in rural areas. Concerning preferential admission from rural areas, we will discuss if national and local contexts makes a difference

Combining education and income into a socioeconomic position score for use in studies of health inequalities

Background: In studies of social inequalities in health, there is no consensus on the best measure of socioeconomic position (SEP). Moreover, subjective indicators are increasingly used to measure SEP. The aim of this paper was to develop a composite score for SEP based on weighted combinations of education and income in estimating subjective SEP, and examine how this score performs in predicting inequalities in health-related quality of life (HRQoL). Methods: We used data from a comprehensive health survey from Northern Norway, conducted in 2015/16 (N=21,083). A composite SEP score was developed using adjacent-category logistic regression of subjective SEP as a function of four education and four household income levels. Weights were derived based on these indicators’ coeffcients in explaining variations in respondents’ subjective SEP. The composite SEP score was further applied to predict inequalities in HRQoL, measured by the EQ-5D and a visual analogue scale. Results: Education seemed to infuence SEP the most, while income added weight primarily for the highest income category. The weights demonstrated clear non-linearities, with large jumps from the middle to the higher SEP score levels. Analyses of the composite SEP score indicated a clear social gradient in both HRQoL measures. Conclusions: We provide new insights into the relative contribution of education and income as sources of SEP, both separately and in combination. Combining education and income into a composite SEP score produces more comprehensive estimates of the social gradient in health. A similar approach can be applied in any cohort study that includes education and income data

The association between health anxiety, physical disease and cardiovascular risk factors in the general population – a cross-sectional analysis from the Tromsø study: Tromsø 7

Background: Health anxiety (HA) is defined as a worry of disease. An association between HA and mental illness has been reported, but few have looked at the association between HA and physical disease. Objective: To examine the association between HA and number of diseases, different disease categories and cardiovascular risk factors in a large sample of the general population. Methods: This study used cross-sectional data from 18,432 participants aged 40 years or older in the seventh survey of the Tromsø study. HA was measured using a revised version of the Whiteley Index-6 (WI-6-R). Participants reported previous and current status regarding a variety of different diseases. We performed exponential regression analyses looking at the independent variables 1) number of diseases, 2) disease category (cancer, cardiovascular disease, diabetes or kidney disease, respiratory disease, rheumatism, and migraine), and 3) cardiovascular risk factors (high blood pressure or use of cholesterol- or blood pressure lowering medication). Results: Compared to the healthy reference group, number of diseases, different disease categories, and cardiovascular risk factors were consistently associated with higher HA scores. Most previous diseases were also significantly associated with increased HA score. People with current cancer, cardiovascular disease, and diabetes or kidney disease had the highest HA scores, being 109, 50, and 60% higher than the reference group, respectively. Conclusion: In our general adult population, we found consistent associations between HA, as a continuous measure, and physical disease, all disease categories measured and cardiovascular risk factors

Oppfølging av plan for helse- og sosialtjenester til den samiske befolkning i Norge

Evaluering av oppfølgingen av NOU 1995:6 Plan for helse- og sosialtjenester til den samiske befolkningen i Norge.Målet med evalueringen var å beskrive, analysere og vurdere oppfølgingen av NOU 1995:6 Plan for helse- og sosialtjenester til den samiske befolkningen i Norge. Evalueringen har en kvalitativ metodisk tilnærming hvor oppfølgingen blant helse- og sosialtjenesteprodusenter, i forvaltningen, ved forsknings- og utdanningsinstitusjoner og i Helsedepartementet er fokusert. I tillegg evalueres Sametingets forvaltning av tilskuddsmidler. NOU’en har utvilsomt skapt en større bevissthet om at samiske brukere kan ha spesielle behov sammenliknet med andre brukere. Det er imidlertid ingenting som tyder på at man har nådd NOU’ens overordnede mål om å skape en helse- og sosialtjeneste for den samiske befolkningen som er likeverdig med den som ytes til den øvrige befolkningen. Til det er mangelen på kompetanse i samisk språk og spesielt samisk kulturforståelse altfor stor. Materialet avdekker noen barrierer mot endring som i hovedsak handler om holdninger, mangel på kompetanse og mangel på ressurser. Rekrutteringen av personell har vært lite målrettet og planverk som angir retning for tjenestenes arbeid med samiske brukere synes i mange tilfeller å mangle