The role of cancer coordinators in improving collaboration in cancer care at local levels following the coordination reform

Abstract

The present study is devoted to one area of change in the Norwegian cancer care associated with the Coordination Reform implemented in 2012. More specifically, my aim has been to shed light on the role cancer coordinators play in cancer care provision at local levels. This underlies both the theoretical presentation and the empirical study undertaken. Cancer coordinator positions were initiated in many municipalities following the Coordination Reform, as part of a trial project implemented by the Norwegian Cancer Society. The main objectives of these positions were to facilitate an increased coordination of cancer care at local levels, to optimize the level and timeliness of care for patients, their next-of-kin and health personnel serving this population in municipalities. As such, implementing cancer coordinator positions was a means to improve the provision of care and assistance for cancer patients and their families in municipalities and to enhance the development and maintenance of adequate collaboration between various municipal and non-municipal health care professionals, organizations, services and institutions to ensure the best possible practice in the area of cancer care (Kreftforeningen 2013). This thesis investigates the theoretical backgrounds for the cancer coordinator initiative and describes the impact of cancer coordinators’ activity on the provision of patient-centered care and cancer care coordination, as viewed by the cancer coordinators themselves. Utilizing a post-New Public Management framework in the theoretical examination allows me to shed light on the explicit and more implicit backgrounds for the implementation of cancer coordinators in municipalities, and to analyze various outcomes as expressed by cancer coordinators in light of this theoretical approach. As the implementation of cancer coordinator positions is inherently interconnected with the Coordination Reform, I have included a brief discussion of this reform from the same theoretical perspective. Post-New Public Management ideas are characterized by processes aimed to enhance both horizontal and vertical coordination, resulting in greater cross-sectoral collaboration and integration and focuses on value-based management and pro-active leadership (Ling 2002; Alford 2002; Pollitt 2003; Stoker 2006; O’Flynn 2007; Christensen and Lægreid 2007). The quantitative study has demonstrated that the implementation of the cancer coordinator trial project in several Norwegian municipalities has had a positive impact on the provision of patient-centered care and cancer care coordination, as viewed by the cancer coordinators themselves. In particular, the majority of cancer coordinators reported that they had good or very good communication with cancer patients and were capable of meeting cancer patients’ needs, ensuring a positive impact of their activities on the patients’ life situation. Furthermore, cancer coordinators commonly used home-visits as a means of communication with cancer patients and their next-of-kin. Cancer coordinators participated in supervision and education of cancer patients and their families in the municipality at least monthly. The majority of cancer coordinators denoted very good or good collaboration with palliative care and cancer care nurses, oncological outpatient departments, palliative care departments, nursing homes and cancer coordinators of other municipalities and/or representatives of the Norwegian Cancer Society. Moreover, cancer coordinators initiated and maintained collaborative actions with several concerned parties in the municipalities by means of attending or arranging joint meetings at least monthly. On the other hand, this study also revealed organizational and communication difficulties within the area of cancer care, which need to be considered and resolved to further improve the level of care and cancer care coordination. In particular, cancer coordinators denoted that it was sometimes quite difficult or even not possible to communicate and collaborate on cancer patients with general practitioners, NAV, schools and/or kindergartens. In addition, the majority of cancer coordinators reported that better collaboration with general practitioners about new and existing cancer patients, as well as better interaction with hospitals and municipal services, could make their work more effective. Comparisons of the results from this empirical analysis with the results of studies conducted in similar areas in national and international contexts indicate the presence of common features, particularly with regard to the difficulties in maintaining an appropriate level of coordination. A comparison of the obtained results with the results of the evaluation report of the Norwegian Cancer Society shows that the results of the present study are in line with those reported by the Norwegian Cancer Society. Cancer coordinators have been shown to provide enhanced patient-centered care for cancer patients and maintain cancer care coordination at local levels. However, the process of cancer care coordination among services, institutions and organizations is considered complicated and has been shown to exceed the resources available to cancer coordinators. As a consequence, cancer coordinators’ interaction and collaboration with several health care and municipal services need to be improved.