We explore what happens to home-based healthcare practice 11 years after implementing a healthcare reform, the Coordination Reform in 2012.
We conducted a qualitative study using document analysis and five focus group interviews with 27 department leaders in home-based healthcare practices in 2023. An inductive thematic analysis was conducted.
Our qualitative design sheds light on how macro-ideas, reforms, and policies shape practice across healthcare institutions and the challenges they face. It highlights that reforms, often driven by efficiency goals, rarely lead to swift changes due to resistance rooted in established norms, values and practices. Still eleven years post-reform, we observe minimal progress in cross-level clinical coordination. The study identifies key barriers, including issues with information flow, trust and collaboration between hospitals and municipal healthcare services. Additionally, it examines the role of path dependency, explaining the persistence of prior routines despite reforms and provides a theoretical lens for understanding resistance to change in healthcare.
By applying institutional theory to healthcare reforms, policymakers and practitioners can better navigate the complex forces shaping healthcare policy.
Our findings illustrate how macro-ideas and policies are diffused across institutional levels in the municipality healthcare sector and how organizational actors and their immediate context shape practice when it comes to cross-clinical coordination.
