Building Trust and Communication with Governance

Demographic trends, combined with the difficulty of recruiting skilled personnel to some regions in the Nordic region, require coordinated distance spanning solutions to ensure access to high-quality healthcare and care in all regions. In this context, interaction and collaboration between various healthcare and welfare providers is a key element in making things work for those who are in need of welfare services. However, we have seen that it is precisely such collaboration that has been difficult to get to work well.

– It is easy to say, “if we would simply collaborate more, things will be great.” But it’s in the transitions between different service levels that mistakes, and problems arise. Inadequate interaction and lack of communication and coordination lead to patient injuries, unnecessary hospital admissions, long waiting times and extra strain for patients as well as for healthcare and social care professionals, comments Bengt Andersson, project manager at the Nordic Welfare Centre.

In the publication Integrated Healthcare and Care through Distance Spanning Solutions – for increased service accessibility, the authors explain what is needed for regions and municipalities to be able to properly work together. The publication includes a theoretical section and five regional examples of collaboration in the Nordic region. The theoretical part focuses on governance and the components that make governance successful. It has been written by researchers in Norway at the Norwegian Centre for E-health Research.

There are several reasons why collaborations are difficult:

• differing and conflicting perspectives
• conflicts concerning which goals should be achieved
• cooperation takes place in the absence of hierarchy

Governance frameworks increase the understanding of complexity

The report shows how different regions in Norden are organised, what they have in common and what is different. With a view of facilitating a better understanding these similarities and differences, the authors present a theoretical framework on governance. The governance framework has proven useful when looking at the complexity that characterises the organisations and the introduction of e-health and distance spanning solutions such as telehealth technologies.

Governing, in its simplest form, means making decisions and in that there is also an expectation that those affected by the decisions will respect and comply with them. Through this governance framework, we can see that each stakeholder goes through different processes.

Governance, as defined in the report, can be seen as an answer to how to deal with the challenges and difficulties that arise. In the case of the first challenge – and various conflicting perspectives – the solution is communication between the parties involved and their working together to establish a common understanding of reality. Secondly, when looking at the problem of conflicting goals, the solution is the development and support for common goals. Finally, in the absence of hierarchy, trust and confidence must be both established and maintained.

The authors summarise these three specific characteristics as being necessary for governance to succeed:

• sharing of knowledge and communication
• common goals
• trust.

Importance and characteristics of governance

In the report, the authors define the specificity of governance by means of some characteristics. The first is that the participants are interdependent – they are trying to achieve something that can only be done by working together, for example by using the various resources of the parties involved, which may be such things as expertise or local knowledge.

The second characteristic is that governance is only possible when all parties can engage in discussion and reach agreements. Directives or orders do not work. Coercion can lead to the withdrawal of other participants who contribute important resources.

The third characteristic is that governance is an effort to follow through on ideas and achieve something. Common goals, potential strategies and activities are planned and coordinated in advance. Partners who use governance as a way of leading will resemble a formal organisation, albeit the hierarchy will be more relaxed than one would expect.

Five Nordic model regions

The remainder of the report contains five case studies of how the three distinct problems with communication, common goals, and trust are managed within five Nordic regional networks. It presents how the regions involved are working to ensure that communication and knowledge sharing, common goals and trust are realised in their projects, whatever stage they may be at.

The five model regions are at different stages – Denmark, Sweden, and Norway have established organisations, while Finland and Iceland are conducting pilot activities.

The five regions are:

Region of Southern Denmark – Syddanmark with 22 municipalities, the Päijät-Häme district in Finland, Fjallabyggð Municipality in northern Iceland, the Agder (Sørlandet) region in the southern part of Norway, and Tiohundra Norrtälje in Sweden.