Managing development plans in the Norwegian healthcare system

Abstract

Background: As part of a national plan to govern professional and organizational development in Norwegian specialist healthcare, the country’s hospital clinics are tasked with making development plans. Using the development plan as case, the paper analyses how managers navigate and legitimize the development plan process among central actors, and deals with the tension between governmental control and organizational autonomy in such strategy work.Method: This study applies a qualitative research design, triangulating different kinds of data. The study was performed in two steps: a) an analysis of various guidelines for development plans and how they are translated through the different levels of Norwegian specialist healthcare, and b) a single-case study of the process of developing a development plan at the clinical level. Findings: Findings shows that the development plan was shaped through a multilevel translation process consisting of different contending rationalities. At the clinical level, the management had difficulties legitimizing the process. Underlying tension between top-down and bottom-up steering challenged their involvement and made it difficult to manage the contingency of decisions.Conclusions: The findings are relevant to public sector managers working on strategy documents, as well as to policymakers identifying challenges that might hinder fulfillment of political intentions. This paper uses a case from Norway; however, the findings are of general interest. It contributes to the academic discussion on how to take account both the health authorities perspective and the organizational perspective in order to understand tensions between control and autonomy, applied to a functionally differentiated health care system.