«Ambulant akutteam - Et sikkerhetsbelte for mennesker i psykisk krise?»

The objective of this study is to contribute with in-depth knowledge based on persons’ subjective experiences within mental health crisis and support and help from a Crisis Resolution/Home Treatment (CR/HT) team. The study has a qualitative, exploratory design and qualitative interviews were conducted with seven persons. They have experiences with both inpatient treatment in hospitals and support from a CR/HT teams. The informants revealed a variety of experiences as service users in the different helping contexts. The experiences of the CR/HT team’s accessibility, availability and flexibility, was highlighted as important.  The Service users felt they were taken more seriously and met as a fellow human being in the home setting as opposed to hospital ward. The informants also emphasized how the CR/HT team helped them to feel more safe and secure. This study offers some in-depth insights of being on the receiving end of mental health services. It is important to include experience based user knowledge in the evidence base of practice development

Trust-based service innovation of municipal home care. A longitudinal mixed methods study

Background: In Scandinavia, various public reforms are initiated to enhance trust in the healthcare services and the public sector in general. This study explores experiences from a two-step service innovation project in municipal home care in Norway, coined as the Trust Model (TM), aiming at developing an alternative to the purchaser-provider split (PPS) and enhancing employee motivation, user satisfaction, and citizen trust. The PPS has been the prevalent model in Norway since the 1990s. There is little empirical research on trust-based alternatives to the PPS in health- care. The overall objectives of this study were to explore facilitators and barriers to trust-based service innovation of municipal homecare and to develop a framework for how to support the implementation of the TM. Methods: The TM elements were developed through a comprehensive participatory process, resulting in the deci- sion to organize the home care service in small, self-managed and multidisciplinary teams, and trusting the teams with full responsibility for care decisions and delivery within a limited area. Through a longitudinal mixed methods case study design a) patients’ expressed values and b) factors facilitating or preventing the service innovation process were explored through two iterations. The first included three city districts, three teams and 80 patients. The second included four districts, eight teams and 160 patients. Results: The patient survey showed patients valued and trusted the service. The team member survey showed increased motivation for work aligned with TM principles. Both quantitative and qualitative methods revealed a series of facilitators and barriers to the innovation process on different organizational levels (teams, team leaders, system). The key message arising from the two iterations is to keep patients’ values in the centre and recognize the multilevelled organizational complexity of successful trust-based innovation in homecare. Synthesizing the results, a framework for how to support trust-based service innovation was constructed. Conclusions: Trust-based innovation of municipal homecare is feasible. The proposed framework may serve as a tool when planning trust-based innovation, and as a checklist for implementation and improvement strategies. Further research is needed to explore the validity of the framework and its replicability in other areas of healthcare

Tillitsmodellen – hovedpilotering i Oslo kommune 2017-18

Bakgrunn, prosess og antagelser For å møte fremtidens utfordringer når det gjelder hjemmebaserte helsetjenester på en god måte er det behov for innovasjon og fornyelse. Formålet med prosjekt Tillitsmodellen har vært å utvikle et tillitsbasert alternativ til bestiller/utfører-modellen som • tar utgangspunkt i hva en enkelte tjenestemottager opplever som viktig, • gir økt ansvar og myndighet til fagpersonene, og • forenkler og forbedrer kontroll- og rapporteringsrutiner. Tillitsmodellen for de hjemmebaserte tjenestene i form av selvstyrende tverrfaglige team ble utviklet gjennom en omfattende nedenfra-og-opp-prosess i fire bydeler, med medvirkning fra representanter for brukere, fagorganisasjoner og medarbeidere i bydelene. Resultatet ble et nytt tjenestedesign og en ny forvaltningsmodell med saksbehandling i lokale team, med helhetlig ansvar for et avgrenset geografisk område. Man ønsket å oppnå følgende resultater med den nye forvaltningsmodellen: • økt trygghet, tilfredshet og selvbestemmelse for brukerne •økt motivasjon og arbeidsglede for fagpersonalet • økt fleksibilitet, effektivitet og kvalitet i tjenestene. Denne nye forvaltningsmodellen, «Tillitsmodellen», ble forpilotert i tre bydeler høsten 2017 og deretter videreutviklet og hovedpilotert i fire bydeler 2017-18

Implementation of eHealth Technology in Community Health Care: the complexity of stakeholder involvement

Background: The implementation of any technology in community health care is seen as a challenge. Similarly, the implementation of eHealth technology also has challenges, and many initiatives never fully reach their potential. In addition, the complexity of stakeholders complicates the situation further, since some are unused to cooperating and the form of cooperation is new. The paper’s aim is to give an overview of the stakeholders and the relationships and dependencies between them, with the goal of contributing this knowledge to future similar projects in a field seeing rapid development. Methods: In this longitudinal qualitative and interpretive study involving eight municipalities in Norway, we analysed how eHealth initiatives have proven difficult due to the complexity and lack of involvement and integration from stakeholders. As part of a larger project, this study draws on data from 20 interviews with employees on multiple levels, specifically, project managers and middle managers; healthcare providers and next of kin; and technology vendors and representatives of the municipal IT support services. Results: We identified the stakeholders involved in the implementation of eHealth community health care in the municipalities, then described and discussed the relationships among them. The identification of the various stakeholders illustrates the complexity of innovative implementation projects within the health care domain—in particular, community health care. Furthermore, we categorised the stakeholders along two dimensions (external– internal) and their degree of integration (core stakeholders, support stakeholders and peripheral stakeholders). Conclusions: Study findings deepen theoretical knowledge concerning stakeholders in eHealth technology implementation initiatives. Findings show that the number of stakeholders is high, and illustrate the complexity of stakeholders’ integration. Moreover, stakeholder integration in public community health care differs from a classical industrial stakeholder map in that the municipality is not just one stakeholder, but is instead comprised of many. These stakeholders are internal to the municipality but external to the focal actor, and this complicating factor influences their integration. Our findings also contribute to practice by highlighting how projects within the health care domain should identify and involve these stakeholders at an early stage. We also offer a model for use in this context

Therapists’ experience of video consultation in specialized mental health services during the COVID-19 pandemic: Qualitative interview study

Background: As part of political and professional development with increased focus on including service users within mental health services, these services are being transformed. Specifically, they are shifting from institutional to noninstitutional care provision with increased integration of the use of electronic health and digitalization. In the period from March to May 2020, COVID-19 restrictions forced rapid changes in the organization and provision of mental health services through the increased use of digital solutions in therapy. Objective: The aim of this study was to develop and advance comprehensive knowledge about how therapists experience the use of video consultation (VC). To reach this objective, we evaluated therapists’ experiences of using VC in specialized mental health services in the early phase of COVID-19 restrictions. The following questions were explored through interviews: Which opportunities and challenges appeared when using VC during the period of COVID-19 restrictions? In a short-term care pathway, for whom does VC work and for whom does it not work? Methods: This study employed a qualitative approach based on an abductive strategy and hermeneutic-phenomenological methodology. Therapists and managers in mental health departments in a hospital were interviewed via Skype for Business from March to May 2020, using a thematic interview guide that aimed to encourage reflections on the use of VC during COVID-19 restrictions. Results: Therapists included in this study experienced advantages in using VC under circumstances that did not permit face-to-face consultations. The continuity that VC offered the service users was seen as a valuable asset. Various negative aspects concerning the therapeutic environment such as lack of safety for the most vulnerable service users and topics deemed unsuitable for VC lowered the therapists’ overall impression of the service. The themes that arose in the data analysis have been categorized in the following main topics: (1) VC—“it’s better than nothing”; (2) VC affects therapists’ work situation—opportunities and challenges in working conditions; and (3) challenges of VC when performing professional assessment and therapy on the screen. Conclusions: Experiences with VC in a mental health hospital during COVID-19 restrictions indicate that there are overall advantages to using VC when circumstances do not permit face-to-face consultations. Nevertheless, various negative aspects in the use of VC lowered the therapists’ overall impression of VC. Further qualitative research is needed, and future studies should focus on service users’ experiences, cocreation between different stakeholders, and how to scale up the use of VC while ensuring that the service provided is appropriate, safe, and available

Implementering av velferdsteknologi i helse- og omsorgstjenester : opplæringsbehov og utforming av nye tjenester – en sluttrapport

De kommunale helse- og omsorgstjenestene står overfor store utfordringer framover tilknyttet nye og yngre brukergrupper, flere eldre med hjelpebehov, knapphet på personell og utfordringer relatert til samhandling mellom kommunehelsetjenesten, primærhelsetjenesten og spesialisthelsetjenesten. Framtidens omsorgsutfordringer kan til dels løses ved å ta i bruk mer teknologi. Mye teknologi er allerede tilgjengelig, men løsningene er til dels fragmenterte, lite brukervennlig og effekten er lite dokumentert. Arena Helseinnovasjon AS har sammen med Høgskolen i Buskerud og Vestfold og flere kommuner utviklet velferdsteknologi som nå implementeres. Gjennom et pilotprosjekt i kommunene Risør, Holmestrand, Lier, Kongsberg, samt Nore og Uvdal har digitalt nattilsyn bidratt til økt trygghet og sikkerhet for mennesker med demens. Dette er også fulgt gjennom dette forskningsprosjektet, som er et kvalifiseringsprosjekt finansiert av Oslofjordfondet (del av Regionale forskningsfond). Forskningsprosjektet har hatt fokus på kunnskapsbehov og organisasjonsendringer ved implementering av velferdsteknologi

Tillitsmodellen – hovedpilotering i Oslo kommune 2017-18

Bakgrunn, prosess og antagelser For å møte fremtidens utfordringer når det gjelder hjemmebaserte helsetjenester på en god måte er det behov for innovasjon og fornyelse. Formålet med prosjekt Tillitsmodellen har vært å utvikle et tillitsbasert alternativ til bestiller/utfører-modellen som • tar utgangspunkt i hva en enkelte tjenestemottager opplever som viktig, • gir økt ansvar og myndighet til fagpersonene, og • forenkler og forbedrer kontroll- og rapporteringsrutiner. Tillitsmodellen for de hjemmebaserte tjenestene i form av selvstyrende tverrfaglige team ble utviklet gjennom en omfattende nedenfra-og-opp-prosess i fire bydeler, med medvirkning fra representanter for brukere, fagorganisasjoner og medarbeidere i bydelene. Resultatet ble et nytt tjenestedesign og en ny forvaltningsmodell med saksbehandling i lokale team, med helhetlig ansvar for et avgrenset geografisk område. Man ønsket å oppnå følgende resultater med den nye forvaltningsmodellen: • økt trygghet, tilfredshet og selvbestemmelse for brukerne •økt motivasjon og arbeidsglede for fagpersonalet • økt fleksibilitet, effektivitet og kvalitet i tjenestene. Denne nye forvaltningsmodellen, «Tillitsmodellen», ble forpilotert i tre bydeler høsten 2017 og deretter videreutviklet og hovedpilotert i fire bydeler 2017-18

Implementering av velferdsteknologi i helse- og omsorgstjenester : opplæringsbehov og utforming av nye tjenester – en sluttrapport

De kommunale helse- og omsorgstjenestene står overfor store utfordringer framover tilknyttet nye og yngre brukergrupper, flere eldre med hjelpebehov, knapphet på personell og utfordringer relatert til samhandling mellom kommunehelsetjenesten, primærhelsetjenesten og spesialisthelsetjenesten. Framtidens omsorgsutfordringer kan til dels løses ved å ta i bruk mer teknologi. Mye teknologi er allerede tilgjengelig, men løsningene er til dels fragmenterte, lite brukervennlig og effekten er lite dokumentert. Arena Helseinnovasjon AS har sammen med Høgskolen i Buskerud og Vestfold og flere kommuner utviklet velferdsteknologi som nå implementeres. Gjennom et pilotprosjekt i kommunene Risør, Holmestrand, Lier, Kongsberg, samt Nore og Uvdal har digitalt nattilsyn bidratt til økt trygghet og sikkerhet for mennesker med demens. Dette er også fulgt gjennom dette forskningsprosjektet, som er et kvalifiseringsprosjekt finansiert av Oslofjordfondet (del av Regionale forskningsfond). Forskningsprosjektet har hatt fokus på kunnskapsbehov og organisasjonsendringer ved implementering av velferdsteknologi

Tillitsmodellen – hovedpilotering i Oslo kommune 2017-18

Bakgrunn, prosess og antagelser For å møte fremtidens utfordringer når det gjelder hjemmebaserte helsetjenester på en god måte er det behov for innovasjon og fornyelse. Formålet med prosjekt Tillitsmodellen har vært å utvikle et tillitsbasert alternativ til bestiller/utfører-modellen som • tar utgangspunkt i hva en enkelte tjenestemottager opplever som viktig, • gir økt ansvar og myndighet til fagpersonene, og • forenkler og forbedrer kontroll- og rapporteringsrutiner. Tillitsmodellen for de hjemmebaserte tjenestene i form av selvstyrende tverrfaglige team ble utviklet gjennom en omfattende nedenfra-og-opp-prosess i fire bydeler, med medvirkning fra representanter for brukere, fagorganisasjoner og medarbeidere i bydelene. Resultatet ble et nytt tjenestedesign og en ny forvaltningsmodell med saksbehandling i lokale team, med helhetlig ansvar for et avgrenset geografisk område. Man ønsket å oppnå følgende resultater med den nye forvaltningsmodellen: • økt trygghet, tilfredshet og selvbestemmelse for brukerne •økt motivasjon og arbeidsglede for fagpersonalet • økt fleksibilitet, effektivitet og kvalitet i tjenestene. Denne nye forvaltningsmodellen, «Tillitsmodellen», ble forpilotert i tre bydeler høsten 2017 og deretter videreutviklet og hovedpilotert i fire bydeler 2017-18

Exploring resistance to implementation of welfare technology in municipal healthcare services – a longitudinal case study

Abstract Background Industrialized and welfare societies are faced with vast challenges in the field of healthcare in the years to come. New technological opportunities and implementation of welfare technology through co-creation are considered part of the solution to this challenge. Resistance to new technology and resistance to change is, however, assumed to rise from employees, care receivers and next of kin. The purpose of this article is to identify and describe forms of resistance that emerged in five municipalities during a technology implementation project as part of the care for older people. Methods This is a longitudinal, single-embedded case study with elements of action research, following an implementation of welfare technology in the municipal healthcare services. Participants included staff from the municipalities, a network of technology developers and a group of researchers. Data from interviews, focus groups and participatory observation were analysed. Results Resistance to co-creation and implementation was found in all groups of stakeholders, mirroring the complexity of the municipal context. Four main forms of resistance were identified: 1) organizational resistance, 2) cultural resistance, 3) technological resistance and 4) ethical resistance, each including several subforms. The resistance emerges from a variety of perceived threats, partly parallel to, partly across the four main forms of resistance, such as a) threats to stability and predictability (fear of change), b) threats to role and group identity (fear of losing power or control) and c) threats to basic healthcare values (fear of losing moral or professional integrity). Conclusion The study refines the categorization of resistance to the implementation of welfare technology in healthcare settings. It identifies resistance categories, how resistance changes over time and suggests that resistance may play a productive role when the implementation is organized as a co-creation process. This indicates that the importance of organizational translation between professional cultures should not be underestimated, and supports research indicating that focus on co-initiation in the initial phase of implementation projects may help prevent different forms of resistance in complex co-creation processes