Experiences from Decentralised Radiological Services in Norway- a rural case study

Abstract

Background:Implementation of the Norwegian government’s Coordination Reform (2012) aims to decentralisehealth care services from centralised hospitals to local communities. Radiological services in Norway are mainlyorganised in hospitals, because of the significant financial and human resource demands engendered by the needfor advanced technological equipment, and specialised staff. Some selected conventional x-ray services have beendecentralised into rural communities. The purpose of this single case study was to highlight experiences fromdifferent stakeholders’of organising decentralised radiological services in a rural area in Norway.Methods:A qualitative single case study design was adopted, collected data using focus groups with healthcareprofessionals and managers to obtain stakeholder’s experiences of the radiological services in this rural area. Thekey emergent themes from the literature, decentralisation, quality, professional roles, organisation and economicconsequences were discussed with each focus group. Thematic analysis was used for analyzing the primary datacollected.Results:Four main themes emerged from the focus groups: 1) organisation, 2) quality and safety, 3) funding ofradiological services and 4) cooperation between health care professions and health care levels. It was found thatthe organisation of decentralised radiological services to rural areas is challenging because of the way healthservices are structured in Norway. The quality of service was found to be inadequate in some areas because of thesuperficial level of training given to non-radiographic staff. The experience is that the Norwegian funding systemhinders an efficient decentralised health care service. Effective cooperation and responsibility between health careprofessions and levels was challenging. There needs to be improved co-working by clearly defining roles andresponsibilities.Conclusions:A key recommendation for the organisation of rural radiological service was the development of asatellite link with an acute hospital. Quality of the service could be improved and should be given priority.Structural change to the financial system whereby money follows patients, might also facilitate more patientcentredservices across healthcare levels. Improved mutual understanding between rural radiological services and hospitalspecialists and managers is important for a high quality and consistent radiological service to be delivered acrossNorway.