Introduction:This article summarizes and synthesizes the findings of four separate but inter-linked empirical projects which explored challenges of collaboration in the Norwegian health system from the perspectives of providers and patients. The results of the four projects are summarised in eight articles.Methods:The eight articles constituted our empirical material. Meta-ethnography was used as a method to integrate, translate, and synthesize the themes and concepts contained in the articles in order to understand how challenges related to collaboration impact on clinical work.Results:Providers’ collaboration across all contexts was hampered by organizational and individual factors, including, differences in professional power, knowledge bases, and professional culture. The lack of appropriate collaboration between providers impeded clinical work. Mental health service users experienced fragmented services leading to insecurity and frustration. The lack of collaboration resulted in inadequate rehabilitation services and lengthened the institutional stay for older patients.Conclusion:Focusing on the different perspectives and the inequality in power between patients and healthcare providers and between different providers might contribute to a better environment for achieving appropriate collaboration. Organizational systems need to be redesigned to better nurture collaborative relationships and information sharing and support integrated working between providers, health care professionals and patients.

The increasing complexity of the healthcare system and of patients' conditions, as well as resource limitations, calls for collaboration between professionals and institutions. The objective of this study was to explore the significance of professional roles in collaboration on patients' transitions from hospital to home via an intermediate care unit. We studied collaboration in the intermediate unit and between healthcare providers in the unit, a hospital and four municipalities in the hospital catchment area. Data were drawn from interviews with thirty-eight healthcare providers within specialist and primary health care and from observations in six multidisciplinary meetings, six report meetings and four discharge meetings in the unit. Transcripts of interviews and observations were analysed using a method of systematic text condensation. The results show that collaboration inside the intermediate unit and between the healthcare institutions was primarily 'a nursing matter'. Collaboration among the nurses was generally good. Except for the physician, all the healthcare providers experienced the collaboration in the unit as unidisciplinary rather than interprofessional. Although they wanted to collaborate interprofessionally, they were unable to do so in practice. The unit's physiotherapists and occupational therapists found themselves to be excluded from the nurses' community of practice, while the physician experienced the collaboration as excellent. The findings indicate that healthcare providers have different understandings of interprofessional collaboration and that in certain situations, they consider interprofessional collaboration to be an inappropriate working method. Interprofessional collaboration can promote a learning environment among healthcare providers. To achieve better interprofessional collaboration, it is probably necessary to create mutual understandings of interprofessionality and to reach an agreement on the situations in which it is an appropriate way to work.

User participation has become an increasingly important principle in health care over the last few decades. Healthcare professionals are expected to involve patients in treatment decisions. Clear guidance as to what this should entail for professionals in clinical work is not accounted for in legislation. In this study, we explore how healthcare professionals in a Municipal Acute Ward perceived, experienced and performed user participation. The ward represents a new short-time service model for emergency assistance in Norway. We focused on the challenges the professionals faced in clinical work and how they dealt with these. Data were drawn from qualitative interviews with 11 healthcare professionals and from 10 observations in relation to previsits and physician's rounds in the ward. Transcripts of interviews and observations were analysed using a method for systematic text condensation. In the analysis, we applied Lipsky's perspective on dilemmas of street-level bureaucrats. The results show that that the professionals perceived user participation as an important and natural part of their work. They experienced difficulties related to collaboration with patients, caregivers, and professionals in other services, and with framework conditions that caused conflicting expectations, responsibility, and priorities. The professionals seemed to take a pragmatic approach to user participation, managing it within narrow perspectives. Our study indicates that the participants dealt with the dilemmas at the cost of user participation. The results demonstrate that there is a gap between the outlined health policy and the professionals' opportunities to fulfil this policy in clinical work regarding user participation. The policy decision-makers should recognise the balancing work required of healthcare professionals to deal with difficulties in clinical work. The knowledge that professionals possess as performers of services and the need for valuing in policy processes should be acknowledged.

To recruit, support and retain a multidisciplinary staff to the best interest of patients, it seems to be important to perform care work as a balance between relational, practical and moral activities.