Linstad Line Helen, Bjørnå Hilde, Moen Anne, Tunby Kristiansen Truls, Hansen Anne Helen
Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
Norwegian Centre for E-health Research, Tromso, Norway.
J Med Internet Res. 2024 Dec 4;26:e59717. doi: 10.2196/59717.
Governments and policy makers struggle to achieve a balance between hierarchical steering and horizontal governance in systems characterized by fragmented decision authority and multiple interests. To realize its One Citizen-One Journal eHealth policy vision, the Norwegian government established a special eHealth board of stakeholders to create an inclusive governance model that aligned stakeholders' interests with the government's ambitions through coordination and consensus. Little empirical knowledge exists on how countries realize inclusive governance models.
This study aims to investigate how the Norwegian inclusive eHealth governance model was developed as a tool to align the government's policy ambitions with stakeholders' concerns from January 2012 to December 2022.
This document study used a thematic analysis based on a constructivist research approach. We included 16 policy documents and 175 consultation response documents issued between January 2012 and December 2022 related to the Norwegian One Citizen-One Journal policy implementation process. The themes were constructed deductively from a review of governance models and public governance theory and were applied as our analytical lens to each document. The findings were interpreted, analyzed, and synthesized.
The national policy implementation process progressed through 3 phases, with changes in stakeholder inclusion and perceived influence on the decision-making process characterizing transitions from phase to phase. Tension developed between 2 contrasting views regarding top-down government authority and stakeholders' autonomy. The view of the regional health trusts, municipalities, health care professional organizations, and industry actors contrasted with that of the patient organizations. Governmental insensitivity to participation, lack of transparency, and decreasing trust by stakeholder groups challenged the legitimacy of the inclusive governance model.
We illustrated that Norway's One Citizen-One Journal policy trajectory was characterized by a process that unfolded across 3 distinct phases. The process was characterized by 2 contrasting stakeholder perspectives. Finally, it was shaped by diminishing trust in the inclusive governance model. The National eHealth Governance Board faced challenges in establishing legitimacy as a top-down inclusive governance model, primarily attributed to its addressing of participation, transparency, and trust dilemmas. Such dilemmas represent significant obstacles to inclusive governance models and require ongoing governmental vigilance and responsiveness from governmental entities.
在决策权力分散且利益多元的系统中，政府和政策制定者努力在层级式指导与横向治理之间取得平衡。为实现其“一人一病历”电子健康政策愿景，挪威政府设立了一个由利益相关者组成的特别电子健康委员会，以创建一种包容性治理模式，通过协调与共识使利益相关者的利益与政府的目标保持一致。关于各国如何实现包容性治理模式的实证知识尚少。
本研究旨在调查2012年1月至2022年12月期间，挪威包容性电子健康治理模式是如何作为一种工具发展起来的，以使政府的政策目标与利益相关者的关切相契合。
本文件研究采用基于建构主义研究方法的主题分析。我们纳入了2012年1月至2022年12月期间发布的16份政策文件和175份咨询回复文件，这些文件与挪威“一人一病历”政策实施过程相关。主题是从对治理模式和公共治理理论的回顾中演绎构建的，并作为我们分析每份文件的视角。对研究结果进行了解释、分析和综合。
国家政策实施过程经历了三个阶段，各阶段之间的转变以利益相关者参与度的变化以及对决策过程的感知影响为特征。在关于自上而下的政府权威和利益相关者自主权的两种截然不同的观点之间产生了紧张关系。地区医疗信托机构、市政当局、医疗保健专业组织和行业参与者的观点与患者组织的观点形成了对比。政府对参与的漠视、缺乏透明度以及利益相关者群体信任度的下降，对包容性治理模式的合法性构成了挑战。
我们表明，挪威“一人一病历”政策轨迹的特点是一个跨越三个不同阶段展开的过程。该过程的特点是利益相关者的两种截然不同的观点。最后，它受到对包容性治理模式信任度下降的影响。国家电子健康治理委员会在确立作为自上而下的包容性治理模式的合法性方面面临挑战，这主要归因于其对参与、透明度和信任困境的处理。此类困境是包容性治理模式的重大障碍，需要政府持续保持警惕并做出回应。
