Integrated care for people with complex needs is perceived to be complex, fragmented and not very well coordinated. Population declines in rural areas, more comorbidity and increased life expectancy, requires the public healthcare to be more efficient - the current operating model is not sustainable. Integrated services are therefore a prioritized area (Anvik et al 2019; Raus et al 2020). There are at least 175 definitions (Murtagh et al 2021); thus, there is no consensus of the term integrated care. Current research of integrated care differs regarding to the empirical context, methodological and theoretical approaches (Anvik 2019; Raus et al 2020). Thus, results from the various studies cannot easily be transferred to other empirical contexts - with little or no practical relevance. However, research on integrated care has until recently been concerned with formal systems for managing integrated care, including their impacts. There has been less focus on the actual formal and informal management of integrated services (Mitterlechner 2020). There is thus little research-based knowledge about healthcare trajectory management, in general as well as in connection with the integration of care across levels and professional boundaries (Allen 2018); there is a demand for empirical, theoretical and conceptual knowledge of how coordination and organization of various services takes place in “real life”, which barriers exist, and when and in which situations they occur (Anvik et al 2019; Raus et al 2020). That is, healthcare trajectory management in rural communities.
The empirical context for the project is the Valdres model (ROP 2020), which is a new collaboration model in the process of being implemented in a middle-sized Norwegian hospital and the six municipalities in a rural part of Norway called Valdres. The background for the model is the challenges of ensuring integrated care for people with severe psychiatric disorders and/or substance abuse who require complex care from the secondary as well as primary care.
The objective of the Ph.D.-project is to fill the gap of knowledge about mechanisms for coordinating health care: the actual work that 'someone' does to keep the interaction/coordination between the various actors in primary and secondary health services in the care trajectory.
The PhD-study is divided into three sub-studies, where two completely different settings/fields are first studied separately, and then compared. The study is exploratory and abductive where we rely on Allen's (2018) Translational Mobilisation Theory (TMT) in the interpretation of the empirical data.
The first study will explore how the projects of collective action are characterised (by emerge, complexity and uncertainty) in a rural setting where collaboration not yet is formally implemented. The second study will examine how the projects of collective action are characterised in a different setting where formal collaboration already is implemented. However, with an unknown degree of integration. The third study will compare data from the two previous studies; the project will extend the use of the TMT framework and concrete illustrate its potential in a different empiric context.
