Health collaboration between municipality and hospital

Desire for peace of mind for patients

The collaboration project was established to address a well-known and demanding problem in the health service: The transitions between municipality and hospital are often vulnerable. Information can be lost, routines can differ - and both patients and staff can feel insecure.

During the project period, two nurses have been employed in 100 per cent combined positions, rotating between them every six months:

• Home nursing in Flekkefjord municipality
• medical ward at Sørlandet Hospital Flekkefjord

In addition, they have had dedicated time for improvement work and internships in emergency departments, ambulances, GP surgeries and short-term wards.

This has given nurses insight into the entire patient pathway - from everyday life at home, through acute illness and hospitalisation, and back again. This has enabled them to identify specific areas for improvement - and actually implement measures where they are most needed.

 

Nurses: A cultural bridge between municipality and hospital

One of the most important lessons learnt from the project is how the combined positions have acted as a cultural bridge between workplaces, departments and service levels.

- "Some people have called us a 'cultural bridge'. That's a pretty good description, because we're gaining a special insight into the work culture and tasks at the hospital and in the municipality through this project," says nurse and project employee Anne Gesina Røynås.

Common understanding and trust

When nurses know both organisations - their logic, frameworks, professional language and priorities - friction and misunderstandings are reduced. Instead of "us and them", a common understanding of why things are done the way they are is created.

This has contributed to:

• more trust between service levels
• better dialogue in demanding transition situations
• greater understanding of each other's room for manoeuvre

 

Over time, this has strengthened the collaborative culture and laid the foundation for lasting changes - not just in routines, but in the way people work together.

- "It's been interesting for us to lift our perspective out of our 'own bubble' and see all the stages that patients go through. Getting a good overview means that we can achieve more holistic treatment and that we can pass on knowledge about this to those we work with," says nurse and project co-worker Gunn Vehovde.

 

From different routines to common practices - more fluidity in everyday life

The project has led to a number of concrete improvement measures that are now either implemented or under further development. These include:

• More efficient message flow between municipality and hospital
• The information needs of the municipality and the hospital are clarified and structured in a template
• Same information available in both locations
• Clearer patient information at discharge
• More efficient handling of discharge summaries

 

The result is that the systems talk to each other to a much greater extent. This creates peace of mind for patients - and less frustration for employees.

Changed routines have resulted in a better flow of co-operation and more targeted information, which can reduce deviations. Targeted treatment can be started earlier in the hospital when up-to-date information is available at the right time. Resources are used smarter, and more time can be spent where it is needed most: with the patient.

 

The patient notices the difference

For patients, this is first and foremost about security and continuity. When healthcare professionals have an overview of the entire process, patients are less likely to have to explain their situation again.

Patients experience:

• to be better looked after
• that the treatment is connected
• that the information they receive is clearer and more understandable

 

Safer patients also have less need for extra contact with healthcare services afterwards. This improves the patient's quality of life - and results in more sustainable use of resources in the services.

 

As the project now enters the operational phase, the model will be continued in an adjusted and anchored form:

• fixed 100 % positions
• emphasis on clinical work
• time set aside for collaboration and improvement work
• continued rolling every six months

 

There will also be regular workshops and professional days where employees from the municipality and hospital meet to share expertise, exchange experiences and further develop the services.

This way of working can be described as a kind of "house-to-house model" and involves employees actually working in each other's "houses", getting to know everyday life on both sides and building interaction based on closeness, trust and mutual understanding.

 

The initiators and anchoring

The initiative for the project came locally and is firmly rooted in both organisations. The project managers have been Ina Cecilie Lindhom from Flekkefjord Municipality and Anette Årstad from Sørlandet Hospital Flekkefjord.

The project has had broad involvement of employees and management across disciplines and levels. It is precisely this anchoring that has been decisive in enabling the experiences to be taken forward and become part of ordinary operations. Both project managers emphasise that 100% positions are always sought wherever the employee wants them, whether they work at the hospital or in the municipality. They are very enthusiastic when they talk about the collaboration project:

- "These positions are a service innovation and an organisational innovation that facilitates closer collaboration, better patient pathways and more holistic services. "This gives nurses a unique insight into what happens in the 'next stage' of the patient pathway, and a great opportunity to identify areas for improvement," says hospital project manager Anette Årstad.

 

Recruitment through collaboration - not competition

Another important benefit is how the municipality and the hospital now co-operate on recruitment. Instead of competing for the same nurses, attractive positions are developed jointly.

The interaction positions provide:

• broad and relevant experience
• professional development and system understanding
• clear responsibility and real influence

 

This makes the positions attractive to both current employees and new applicants - and contributes to stability over time.

- "We feel that this is a new way of working that contributes to increased expertise, better use of resources and more coherent services for patients. It is also an important contribution to the recruitment and stabilisation of nurses - instead of competing for the same scarce resources, the municipal health service and the specialist health service collaborate on resources," says Ina Cecilie Lindholm, project manager for the municipality.

 

Interest far beyond Flekkefjord

The experiences from Flekkefjord have attracted considerable interest. Several municipalities in the Lister region, as well as other departments in both the municipality and the hospital, have shown interest in learning from the model and considering similar solutions.

The project is also well anchored in national guidelines for coordination, prioritisation and sustainable healthcare, as described in NOU 2023:4 and the National Health and Coordination Plan 2024-2027.

 

Proof of what's possible

The transition from project to permanent operation marks a clear choice of direction:
Collaboration shouldn't be temporary - it should be an integral part of how healthcare actually works.

Flekkefjord shows that even smaller places can lead the way with innovative, sustainable solutions that put both patients and professionals at the centre - and that can inspire far beyond their own borders. When the project managers presented the model at the Norwegian Patient Safety Conference, it aroused great interest, and both the Directorate of Health and KS have found the model inspiring. This seems to be the start of something good - and Flekkefjord is showing the way!