BackgroundIn Central Norway a generic care pathway was developed in collaboration between general hospitals and primary care with the intention of implementing it into everyday practice. The care pathway targeted elderly patients who were in need of home care services after discharge from hospital. The aim of the present study was to investigate the implementation process of the care pathway by comparing the experiences of health care professionals and managers in home care services between the participating municipalities.MethodsThis was a qualitative comparative process evaluation using data from individual and focus group interviews. The Normalization Process Theory, which provides a framework for understanding how a new intervention becomes part of normal practice, was applied in our analysis.ResultsIn all of the municipalities there were expectations that the generic care pathway would improve care coordination and quality of follow-up, but a substantial amount of work was needed to make the regular home care staff understand how to use the care pathway. Other factors of importance for successful implementation were involvement of the executive municipal management, strong managerial focus on creating engagement and commitment among all professional groups, practical facilitation of work processes, and a stable organisation without major competing priorities. At the end of the project period, the pathway was integrated in daily practice in two of the six municipalities. In these municipalities the care pathway was found to have the potential of structuring the provision of home care services and collaboration with the GPs, and serving as a management tool to effect change and improve knowledge and skills.ConclusionThe generic care pathway for elderly patients has a potential of improving follow-up in primary care by meeting professional and managerial needs for improved quality of care, as well as more efficient organisation of home care services. However, implementation of this complex intervention in full-time running organisations was demanding and required comprehensive and prolonged efforts in all levels of the organisation. Studies on implementation of such complex interventions should therefore have a long follow-up time to identify whether the intervention becomes integrated into everyday practice.

Today's healthcare sector is being transformed by several ongoing processes, among them the introduction of new technologies, new financial models and new ways of organising work. The introduction of the electronic patient record (EPR) is representative and part of these extensive changes. Based on interviews with health personnel and office staff in a regional hospital in Norway, and with health administrators and information technology service-centre staff in the region, the article examines how the introduction of the EPR, as experienced by the participants, affects the work practices and boundaries between various professional groups in the healthcare system and discusses the implications this has for the understanding of medical practice. The article shows how the EPR has become part of the professionals' boundary work; expressing shifting constructions of professional identities.

Competence and competence development are ‘buzz words' widely used in organizations in Norway, as well as in other countries. Competence, as the company's most important and valuable resource, is constantly highlighted. But what does this imply for the organization and for the employees? What are comprised in the concept of competence? In this article we present different understandings of competence among employees in a large Norwegian oil company, Statoil, as well as some of the different views on competence found in the literature. Based on semi-structured interviews in two different stages of a process of implementing a netbased learning system, we find that the focus is more on competence as asset than competence as process. This leaves out important dimensions of competence in the complex society of today and as expressed by several of the employees in Statoil.

The need for integration of healthcare services and collaboration across organisational boundaries is highlighted as a major challenge within healthcare in many countries. Care pathways are often presented as a solution to this challenge. In this article, we study a project of developing, introducing and using a care pathway across healthcare levels focusing on older home-dwelling patients in need of home care services after hospital discharge. In so doing, we use the concept of boundary object, as described by Star and Griesemer, to explore how care pathways can act as tools for translation between specialist healthcare services and home care services. Based on interviews with participants in the project, we find that response to existing needs, local tailoring, involvement and commitment are all crucial for the care pathway to function as a boundary object in this setting. Furthermore, the care pathway, as we argue, can be used to push boundaries just as much as it can be used as a tool for bridging across them, thus potentially contributing to a more equal relationship between specialist healthcare services and home care services.

Background Recent decades have seen increased attention to patient safety in health care. This is often in the form of programmes aiming to change professional behaviours. Health professionals in hospitals have traditionally resented such initiatives because patient safety programmes often take a managerialist form that may be interpreted as a challenge to professional identity. Research, however, has mostly paid attention to the role of physicians. This study aims to highlight how such programmes may affect professional nursing identity. Methods We qualitatively investigated the implementation of a patient safety programme in Norway, paying attention to changes in nurses’ practices and values. Based on purposive sampling, two group interviews, four individual interviews and five hours of observational studies were conducted in a hospital department, involving ten nurses and three informants from the hospital management. Interviews were conducted in offices at the hospital, and observations were performed in situ. All the interviews lasted from one to one and a half hours, and were recorded and transcribed ad verbatim. Data was analysed according to ad-hoc meaning generation. Results The following analytical categories were developed: reconstructing trust, reconstructing work, reconstructing values and reconstructing professional status. The patient safety programme involved a shift in patient safety-related decisions, from being based on professional judgement to being more system based. Some of the patient safety work that previously had been invisible and tacit became more visible. The patient safety programme involved activities that were more in accordance with the ‘cure’ discourse than traditional ‘care’ work within nursing. As a result, this implied a heightened perceived professional status among the nurses. The safety programme was – contrary to the ‘normal’ resistance against audit systems – well received because of the raised perceived professional status among the nurses. Conclusions Reconstructing trust, work, values and status, and even the profession itself, is being reconstructed through the work involved in implementing the procedures from the safety programme. Professional knowledge and identity are being challenged and changed, and what counts as good, professional nursing of high quality is being reconstructed. Electronic supplementary material The online version of this article (10.1186/s12913-019-4222-y) contains supplementary material, which is available to authorized users.