Inter- organizational Management in Danish Health Care

1. Inter-organizational Management in Danish Health Care Contribution to 13th International Conference on Integrated Care, April, 11-12 2013, Berlin, Germany JanneSeemann, PhD, Professor, Department of Sociology and Social Work JeppeGustafsson, PhD, Associate Professor, Department of Business Studies Centre of Organization, Management and Administration (COMA)

2. Health CareDanish Structural Reform 2007 • The reform reduced the number of: • 15 counties to 5 regions • 273 municipalities to 98 larger municipalities

3. Health CareDanish Structural Reform 2007 • The Hospitals:owned and administered by the regions, but now financed by the state and the municipalities (the regional level can no longer collect tax revenues). • The general practitioners:a liberal profession, where payment is made according to performance and via service contract with the regions. Now financed by the state and municipality, but administered by the regions. • The municipalities: administered and financed by the municipalities (home care, nursing homes, child dental care). New health tasks have emerged whereby the municipalities assume full responsibility for prevention measures, health promotion and rehabilitation. The municipalities now pay for 20% of hospitalization costs.

4. Health CareDanish Structural Reform 2007 • It is not a case of any sort of revolution in the Danish health care system: • minor transfer of health tasks • significant restructuring of financing the health care system • Main point of departure: to increase the effectiveness of the hospitals • structural rationalization • economies of scale • specialization • financial incentives

5. Health CareDanish Structural Reform 2007 Lessons learned: • the emergence of new interface problems • still unclear divisions of responsibility • economic incentives (municipal co-financing in connection with hospitalization) have not worked as intended

6. Changes in The Hierarchy Implement changes and overcome resistance to change One Management One Problem One solution

7. Changes in The Network Adaptation and influence across the units due to distributed power Several managers Several problems Several (competing) solutions

8. Critical aspects of cooperation • Disagreement over who does what • domain conflicts • Disagreement over treatment technology, working methods and principles • technology conflicts • Disagreement over goals and evaluation criteria • mutual complaints over output and outcome • Differences in the parties’ structures, cultures and processes • making it difficult to reach common ground • Differences in expectations about the methods and organization of cooperation

9. Implications for Inter-organizational Management • Absence of positional power • Management of many dilemmas • Management of horizontal processes • Creation of trust • Creation of appropriate formalization

10. Important conclusions for managers (Inspired by Torfing 2011) • Fight the “no-mistake culture” so that the mistake becomes the point of departure for learning • Limit the tyranny of rules through trust-based leadership • Limit the “counting-up regime” and encourage cross-disciplinary thinking • “Bore” holes in the public silos and create borderless organizations that do not close in on themselves, but are opened up towards other cooperating partners