Implementing cancer patient pathways in Scandinavia how structuring might affect the acceptance of a politically imposed reform

• Published in: Health policy (Amsterdam) 2021-10, Vol.125 (10), p.1340-1350
• Main Authors: Mæhle, Per Magnus, Smeland, Sigbjørn
• Format: Article
• Language: English
• Subjects: Acceptance; Cancer; Cancer care reform; Cancer patient pathways; Counseling; Decision making; Delivery of Health Care; Health Care Reform; Health services; Health-policy research; Hierarchies; Humans; Integrated care pathways; Neoplasms; Patient communication; Patients; Policy implementation; Political change; Reforms; Scandinavia; Scandinavian and Nordic Countries; Social movements
• ISSN: 0168-8510; 1872-6054
• DOI: 10.1016/j.healthpol.2021.08.008

•Similar reform in cancer care was implemented top-down well received and perceived as a success by the professional communities.•This can be explained by a process combining hierarchical governance, specific cancer-related units, project-organization and social movement elements.•These structures allowed actors to move through hierarchical levels, acting as institutional entrepreneurs.•The structuring of implementation combined these rules of interaction: control/command, negotiation, consensus-making and advisory. The specific mixture may influence long term output. Through political decisions all three Scandinavian countries implemented national reforms in cancer care introducing cancer patient pathways. Though resistance from the professional community is common to top-down initiatives, we recognized positive receptions of this reform in all three countries and professionals immediately contributed in implementing the core measures. The implementation of a similar reform in three countries with a similar health care system created a unique opportunity to look for shared characteristics. Combining analytical framework of institutional theory and research on policy implementation, we identified common patterns of structuring of the initial implementation: The hierarchical processes were combined with supplementary structures located both within and outside the formal management hierarchy. Some had a permanent character while others were more project-like or even resembled social movements. These hybrid structures made it possible for actors from high up in the hierarchy to communicate directly to actors at the operational hospital level. Across the cases, we also identified structural components acting together with the traditional command-control; negotiation, consensus and counseling. However, variations in the presence of these did not seem to have significant impact on processes causing decisions and acceptance. These variations may, however, influence the long-term practice and outcome of cancer-care pathway-reform. Knowledge from our study should be considered when orchestrating future health care reforms and especially top-down politically initiated reforms.