Aims: To investigate the differences between Sweden, Denmark, Finland and Norway regarding residential/home care units’ and frontline managers’ background factors, the resources allocated and measures taken during the initial phases of the COVID-19 pandemic, and whether and how these differences were associated with COVID-19 among older people in residential/home units. Methods: Register- and survey-based data. Responses from managers in municipal and private residential/home units. Number of municipal COVID-19 cases from national registries. Multilevel logistic multivariate regression analysis with presence of COVID-19 among older people in residential/home units as the outcome variable. Results: The proportions of residential/home units with client COVID-19 cases, mid-March–April 2020 were Denmark 22.7%, Finland 9.0%, Norway 9.7% and Sweden 38.8%, most cases found in clusters. The proportions were similar among employees. Client likelihood of having COVID-19 was six-fold higher if the employees had COVID-19. Mean client cases per residential/home unit were Denmark 0.78, Finland 0.46, Norway 0.22 and Sweden 1.23. For the same municipal infection incidence class, Sweden’s mean client infection levels were three-fold those of other countries. The regression analysis variables country, municipal COVID-19 incidence proportion, and care type were associated with client cases at p ⩽ .001. Compared with Denmark, the odds ratios (ORs) for Sweden, Norway and Finland were 1.86, 0.41 and 0.35 respectively. The variable difficulties in preventive testing had an OR of 1.56, p ⩽ .05. Conclusions: Municipal COVID-19 incidence, employee cases, and the lack of testing resources somewhat explained the confirmed COVID-19 cases among older people in residential/home units. A two- to five-fold unexplained inter-country difference in ORs in the multivariate analyses was notable. The level of protection of vulnerable older clients in municipal and private residential/home units differed between the included countries.

From 2008 to 2017, a public sector innovation termed reablement diffused among Danish municipalities. We show how this transition is an example of New Public Governance (NPG) strategies supplementing and to some extent replacing New Public Management (NPM) strategies. Further, we analyze the diffusion pattern based on hypotheses derived from the diffusion-of-innovation literature. We find a surprising relationship between fiscal stress and time of adoption. Those municipalities with high levels of fiscal stress adopt early relative to municipalities with lower levels of fiscal stress. Thus, innovation seems to be the politics of ‘hard times’ and as a tool to overcome economic austerity.

I perioden fra 2008 til 2017 har en ny arbejdsform – en innovation kaldet hverdagsrehabilitering – spredt sig blandt danske kommuner. Vi viser, at udviklingen er et eksempel på, hvordan New Public Governance (NPG) strategier supplerer og i nogen grad erstatter New Public Management (NPM) strategier, og undersøger spredningsmønsteret med udgangspunkt i hypoteser fra diffusion-of-innovations-litteraturen. Vi finder en, i forhold til litteraturen, overraskende sammenhæng. Kommuner med stort ressourcepres var hurtigere til at tage hverdagsrehabilitering i brug end kommuner med mindre ressourcepres. Med baggrund heri kan innovation dermed forstås som politics of hard times, og adoptionen af hverdagsrehabilitering – som et eksempel på spredningen af en styringslogik på tværs af kommuner – synes at være drevet af kommunernes økonomiske situation og behov for at nytænke deres opgaveløsning.

Introduction:Home-based reablement (HBR) has achieved significant international prominence in recent years. In the Nordic countries, HBR has been introduced as an innovative care model within the municipal health care sector that answers the need for better and more effective service delivery. But knowledge about how innovations can be spread in the municipal health care sector is scarce. We also know little about what role first-line managers (FLMs) may play for the diffusion of innovations. Purpose: To describe and explain adoption of HBR in municipalities in Norway and to explore if there is a relationship between early/late adoption and the FLM's perception of innovativeness in their organization. Such knowledge is valuable for the understanding of the role of FLM for the diffusion of innovations in the health care sector. Methods: A cross-sectional national online survey was carried out among FLM in the eldercare sector in 422 Norwegian municipalities. The response rate was 64%. The analysis was based on univariate and bivariate techniques, factor analysis, and multiple linear regression. Results: A bivariate analysis revealed that early adoption is associated with a high score on perception of innovativeness among FLMs. Innovators and early adopters scored highest (5.65) on perception of innovativeness, followed by early majority (5.31) and late majority (5.18). The lowest score was found among Laggards. A multiple regression analysis revealed that a substantial part of the positive relationship between early adoption and perception of innovativeness can be explained by FLMs' length of service in the organization and their educational level. Wealth of the municipality does not have an effect on innovativeness. Conclusion: An implication of the results is that mature and stable personnel in key positions in the organization, and personnel with higher education, can be positive for innovativeness in the municipal health care sector.

Reacting rapidly and adequately in the early stages of a crisis is crucial to effective crisis management. This study analyses the relationship between key first-line manager characteristics, early innovation adoption and crisis scenarios in the context of Danish eldercare during the early stages of the COVID-19 crisis. Our findings show that manager characteristics such as education level, eldercare job tenure and previous similar experience are important to early innovation adoption in crises. The study contributes to the crisis management literature by emphasizing the importance of firstline manager characteristics in effective crisis management.