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首页> 外文期刊>BMC Health Services Research >The politics of local hospital reform: a case study of hospital reorganization following the 2002 Norwegian hospital reform
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The politics of local hospital reform: a case study of hospital reorganization following the 2002 Norwegian hospital reform

机译：地方医院改革的政治：以2002年挪威医院改革后的医院重组为例

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Background The Norwegian hospital reform of 2002 was an attempt to make restructuring of hospitals easier by removing politicians from the decision-making processes. To facilitate changes seen as necessary but politically difficult, the central state took over ownership of the hospitals and stripped the county politicians of what had been their main responsibility for decades. This meant that decisions regarding hospital structure and organization were now being taken by professional administrators and not by politically elected representatives. The question raised here is whether this has had any effect on the speed of restructuring of the hospital sector. Method The empirical part is a case study of the restructuring process in Innlandet Hospital Trust (IHT), which was one of the largest enterprise established after the hospital reform and where the vision for restructuring was clearly set. Different sources of qualitative data are used in the analysis. These include interviews with key actors, observational data and document studies. Results The analysis demonstrates how the new professional leaders at first acted in accordance with the intentions of the hospital reform, but soon chose to avoid the more ambitious plans for restructuring the hospital structure and in fact reintroduced local politics into the decision-making process. The analysis further illustrates how local networks and engagement of political representatives from all levels of government complicated the decision-making process surrounding local structural reforms. Local political representatives teamed up with other actors and created powerful networks. At the same time, national politicians had incentives to involve themselves in the processes as supporters of the status quo. Conclusion Because of the incentives that faced political actors and the controversial nature of major hospital reforms, the removal of local politicians and the centralization of ownership did not necessarily facilitate reforms in the hospital structure. Keeping politics at an arm's length may simply be unrealistic and further complicate the politics of local hospital reforms.
机译：背景技术挪威2002年的医院改革是试图通过从决策过程中剔除政治人物来简化医院的重组。为了促进被认为是必要但在政治上困难的变革，中央政府接管了医院的所有权，并剥夺了县政客几十年来的主要职责。这意味着有关医院结构和组织的决定现在由专业管理人员而不是由政治选举产生的代表来决定。这里提出的问题是，这是否对医院部门的重组速度有任何影响。方法：经验部分是对因兰德医院信托公司（IHT）重组过程的案例研究，因兰德医院信托是医院改革后成立的最大企业之一，明确树立了重组的愿景。分析中使用了不同来源的定性数据。其中包括与主要演员的访谈，观察数据和文献研究。结果分析表明，新的专业领导者起初是按照医院改革的意图采取行动的，但很快就选择避免制定更具雄心的医院结构重组计划，而实际上将地方政治重新引入了决策过程。分析进一步说明了地方网络和各级政府的政治代表的参与如何使围绕地方结构改革的决策过程变得复杂。当地政治代表与其他行为者合作，建立了强大的网络。同时，国家政客有动力参与进来，成为现状的支持者。结论由于政治行为者面临的激励和大型医院改革的争议性质，地方政客的撤职和所有权的集中化并不一定会促进医院结构的改革。与政治保持一定距离可能只是不现实，并使本地医院改革的政治复杂化。

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