Table 1
Historical development of coordinator roles in Norwegian hospitals 2001–2016.
| Coordinator roles in hospitals | Year of introduction or change | |||
|---|---|---|---|---|
| 2001 | 2012 | 2015 | 2016 | |
| Individual care plan that includes a personal coordinator for patients with long-term complex needs. (Patient right and healthcare obligation by law, 2001) | X | X | X | X→ |
| Patient responsible physician. All patients. (Regulations 2001) | X | |||
| Patient care coordinator in specialized healthcare for patients with long-term complex needs, whether they want an individual care plan or not. Preferably a physician. (Healthcare obligation by law 2012–2015) | X | |||
| Coordination unit in each hospital. Responsible for the hospital’s work with individual care plans and coordinators. (Regulated since 2001, obligation by law in 2012) | X | X | X | X→ |
| * Patient care coordinator in specialized healthcare. The coordinator may have any health profession. (Law amendment 2015) | X | X→ | ||
| * Hospital contact-physician for seriously ill. (Patient right and healthcare obligation by law 2016) | X→ | |||
[i] * These two roles are the focus of this study.
Table 2
The included documents.
| Document number, document title and which parts of the documents are analysed | Type and status | Topic covered* | Publication year | |
|---|---|---|---|---|
| 1. | Specialized Health Services Act [20]. §§ 2–2, 2–5a, b and c | Current legislation | PCC & CP | 1999, updated 17.6.2016 |
| 2. | Regulations to the Specialized Health Services Act and the Health and Care Services Act concerning rehabilitation, individual plan and patient care coordinator [35]. | Regulations covering the patient care coordinator role | PCC | 2012 |
| 3. | Directive to the Specialized Health Services Act [23]. p. 23–27 | Circular | PCC | 2013 |
| 4. | Law proposition to the Parliament, Prop. 125 L. Amendments to the Specialized Health Care Act. [22]. Chapters 1–8, p. 5–38 and 10, p. 43–46 | Proposition The proposed amendment to the Specialized Health Services Act was approved in November 2015 | PCC & CP | 2014–2015 |
| 5. | Guidelines for patient care coordinator [36]. Chapter 13, p. 82–93 | Document with recommendations and clarifications for how to understand the law paragraphs and regulations regarding rehabilitation, individual care plan and coordinator | PCC | 2015, updated 23.2.2017 |
| 6. | Guidelines for contact physician [37]. Chapters 1–8, p. 1–33 | Document with recommendations and clarifications for how to understand the law paragraphs and regulations regarding contact physician in specialized healthcare | PCC & CP | 2016 |
| 7. | The Coordination Reform. Proper treatment – at the right place and right time. Report No. 47 (2008–2009) to the Storting. [16]. Chapters 1–5, p. 11–53 and 10, p. 111–114 | Report to the Storting from the Minister of Health and Care Services | Background and context | 2009 |
| 8. | NOU 2005: 3. From piecemeal to whole – an integrated health service [38]. Chapters 1, 2, p. 11–21, 4, p. 40–48, 6 and 7, p. 67–87 | Official Norwegian Report delivered to the Ministry of Health and Care Services | Historical background | 2005 |
| 9. | NOU 1997: 2 The patient first! Leadership and organization in hospitals [39]. Chapters 2, p. 15–16 and 8, p. 92–108 | Official Norwegian Report delivered to the Ministry of Social Affairs and Health | Historical background | 1997 |
| 10. | Meld.St.11 (2015–2016) National health- and hospital plan 2016–2019. [40]. Chapter 7.3, p. 57–58 | Report to the Storting from the Minister of Health and Care Services | Current plan for hospitals | 2015 |
[i] * The abbreviation PCC is used for patient care coordinator and CP for contact physician in table 2.
Table 3
Central characteristics of the two coordinator roles.
| Area | Coordinator | |
|---|---|---|
| Patient care coordinator (1,2,3,4,5) | Contact physician (1,4,6) | |
| Purpose | Ensure continuity and coherence in patients’ care pathways. | Enhance the quality of treatment. Contribute to patient safety, predictability and continuity in patients’ pathways. |
| Tasks | Follow up of the individual patient before, under and after hospital stay. Coordinate hospital services between units, departments, and professionals around the patient. Be the point of contact for the patient, collaborating professionals, external service providers and institutions. Secure information and dialogue with the patient. Contribute to progression in the process in the work on the individual care plan (ICP) when this is applicable* | Be a stable contact-person for the patient regarding medical questions. Be involved in treatment or follow up, and be available and inform the patient and next of kin through the course of treatment and follow up. Contribute that the patient trajectory develops as planned. Establish contact with other professionals/units if necessary. Be available for medical questions from primary healthcare or other professionals. The hospital can decide whether the contact physicians also should hold the statutory responsibilities for ‘information to the patient’ and ‘documentation in the patient record’. |
| Assigned profession | Healthcare personnel. (From 2012–2015: ‘Coordinator should preferably be a physician’. This was removed in 2015 in an amendment of the law paragraph). | Physician with relevant competence, preferably a specialist. In mental healthcare and substance abuse treatment, contact psychologist may be appointed in place of contact physician. |
| Target group | Patients with complex or long-term needs of coordinated services under the Act of specialized healthcare. | Patients with serious conditions who are in need of treatment or follow up from specialized healthcare for a period of time. |
| Criteria defining target group | Expected needs of services for the patient from different departments, units and professions in specialized healthcare over time, and the need of coordinated services. | The severity of the condition; risk of disability or death, comorbidity, expected progression. Duration: Need of treatment more than 3–4 days. Need of more than one follow-up consultation. |
| Legal status | Obligation for specialized healthcare (Specialized Health Services Act). Not a legalized right for the patient. | Obligation for specialized healthcare (Specialized Health Services Act). Legalized right for the patient (The Patients’ Rights Act). |
| Implementation status | Various degree of implementation and knowledge in the hospitals (4). National Audit concludes that the goals are not achieved [27]. | Act came into force September 2016. The hospitals are in the process of developing routines for the role as well as procedures and tools for documentation and communication (2017). |
[i] * From being a common responsibility for all healthcare services, the main responsibility for individual care plans was assigned to the municipalities from 2012. When patients need services from both primary and specialized healthcare, the hospitals’ responsibility was confined to informing the patients, reporting patients’ needs of individual care plans to the municipalities, and to collaborate and contribute according to the needs of the individual patient. Specialized healthcare must develop the plan together with the patient, if he or she do not need services from the municipality (5).