The case (Healthy)

As explained in chapter II and in earlier sections in this chapter, a combined study will be

conducted, based on a survey and on a case study. Below facts and methods related to the case

141

3.12.1 Healthy – background and information

Healthy was selected as a case study for several reasons. First, this is a large, complex

company, which is also an important supplier of health services to a high number of people

(2.6 million Norwegians). Second, Healthy is a knowledge based organisation with highly

educated employees, both in the medical staff and in executive management. In such

organisations the use of knowledge and skills will typically be important. In this way Healthy

fits well in with the research questions in this thesis. Third, Healthy had experienced

performance problems for a while when the observations started. These observations of a

company in a challenging situation were thus not based on a sudden crisis, which might

disappear as quickly as it arrived. Conversely, the case was related to a company with issues

over time which had an impact on the whole organisation, making the organisation an

interesting case related to use of knowledge and skills. Fourth, the company has a well-

developed system for publishing information and documents, which makes a triangulation of

the observations easier and better. Fifth, I was allowed to follow the board meetings and make

the interviews, which might be an issue in some companies.

Healthy is one out of four Norwegian regional health companies. These companies are

publicly owned, but their organisation model is similar to that of private companies. Healthy

is provided with a twofold responsibility: 1) Own and operate hospitals as efficiently as

possible and 2) ensure people in the region have adequate supply of specialist care services

(either through own hospitals, private hospitals or hospitals in other regions). In Norway the

responsibility for health is shared between the regional health companies and the

municipalities. While the municipalities are responsible of primary care and long-term care,

Healthy and the other health companies care for secondary (specialist) care and psychiatry.

Healthy was founded in 2007 by a merger of two former, smaller regional health companies,

142

employees were working in the company and the budget was NOK 52 billion (about £6

billion). Healthy has the responsibility of the health services for 2.6 million Norwegians (56

per cent of the total population), covering 10 counties. The services are delivered in 10

different trust hospitals as well as 5 private non-commercial ones.

3.12.2 The governance structure and the board in Healthy

Healthy has a main board which is responsible for the whole company. Totally, there are 10

local health companies. They have all got separate local boards. All the local boards, but two,

have 11 board directors, where 4 of them are elected by and among the employees. The

largest health company has a board of 12 directors, and 5 of them are employee elected. The

smallest company, representing the pharmacies in the hospitals, has 8 directors, and 3 of them

are elected by and among the employees. The directors of the local boards, who are not

employee elected, either work in Healthy or have a background from political activities (since

2005).

Further, Healthy has a corporate assembly, having 2 meetings a year. The directors of the

main board are elected by the corporate assembly. Furthermore, the board members in

Healthy are to

“ensure that patients' and relatives' rights and interests are safeguarded, among other through a regular cooperation with their organisations. The board is also to ensure that the experiences, needs’ assessments, priorities and views collected from patients and their families and organisations, are given a central role in planning and running of the enterprises” (Healthy’s Statutes, § 14).

The members of the local boards are nominated by the main board based on a proposal from

the nomination committee.

Furthermore, the directors who are not elected by employees have no regular political

function. They are elected to contribute with their general knowledge and skills of corporate

143

this point does not seem to be absolutely clear. Typically, on the local websites some of the

health companies report the political affiliation of the members (if any), while other present

the directors through a personal CV.

There are fourteen members in the main board, including five members elected by and from

the employees. Most of the board members in this board have former experience from

political activities (parliament, county boards, and municipalities). The users are represented

round the board table, but they have no right to participate, discuss or vote. Behind the union

representatives there are two large labour organisations and several smaller ones. The chair at

the time of writing is number three in a row. The first one was in office from the start in 2007

until April 2011, while the next was a vice chair and filled in between two elections. The

present chair was further elected in January 2012. The first board chair was a woman, while

the two next ones have been men. Healthy had a female CEO until November 2012. The

current CEO is a man with a medical background, but he has further experience as an

executive manager and a board chair. Finally, six men and eight women are members of the

main board (Healthy's website).

3.12.3 Vision, goals and values in Healthy

The board members are working based on a vision of "High quality health services equal to

all, regardless of age, place of residence, ethnic background, gender or personal economy

(Healthy's website - strategy document 2013-2020).

Healthy is further underlining the importance of quality, safety and respect, and knowledge

based practice is separately mentioned as an important priority area. A central focus on the patients’ needs is coming through in documents with a high degree of details. Examples thereof are two of Healthy’s goals:

144

 Patients should have a doctor appointment as soon as they have got the referral from their general practitioner

In a former strategy document (2007-2012), the goals included one direct statement related to

the board, implementing the board members’ decisions in its restructuring program. This goal

had got the same weight as concrete goals regarding lying days in hospitals, corridor patients,

the speed of patient records and patient safety. In the latest revision of the strategy (2013-

2020) this goal was however, removed, but “quality and knowledge” is still presented as one of the values aligned with “openness and involvement” and “respect and anticipation” – all coined as Healthy’s “building blocks of activity” (Healthy Strategy 2013-2020).

Knowledge management is further defined as a separate chapter in the strategy plan, where

also the necessity of knowledge flow is underlined: "Develop and implement an overall

strategy for knowledge management, improvement efforts and good practice" (Healthy's

website - goals).

In consequence, the text and the goals in the strategy document are focusing on knowledge

and skills for future development. Healthy’s strategy plan thus underpins the arguments

reported in the first part of this section - a case study of this company fits well in with the

subject in the thesis (Healthy's website – Strategy Document 2013-2020).

3.12.4 Healthy - the issues

From the very beginning Healthy has been reported on in the media with alarming news

coming through almost all the time. As a result of the merger, a huge reorganisation project

was initialized. This project has turned out to be controversial, among other factors because of

its several main organisational changes. These changes were initiated in the capital with one

hospital closed down, another further developed and several main services moved between

145

service quality. As a result a large number of employees had to move to other hospitals, some

might lose their work while other might change their working area (Healthy's Website -

Strategy Document); Newspapers articles).

Further, economic issues are obviously present which makes the discussions harder and more

difficult. This reorganisation and the income distribution between the hospitals were in one or

another way mentioned at almost every meeting in the main board, and most of the

interviewees put these issues forward.