Abstract:
This article investigates factors that contributed to the successful introduction of 33 priority guidelines for Norwegian specialist health care from 2008 to 2012. The guidelines constituted an important step in changing the regulation of clinical priority setting from largely self-regulation by medical professionals to a more centralised and hierarchical form, and therefore, resistance from the medical profession was expected. My focus is on organisational factors within the project that developed the guidelines, using policy documents and project documents as the main source of data. I find that the project was characterised by a high level of autonomy in terms of how it was organised and the actors included, with significant capacity for action in terms of both structure and personnel, and a broad inclusion of affected actors. The priority guideline project was dominated by medical professionals, and its organisation did not represent a radical break with established traditions of medical professional self-regulation. Although organisational autonomy, action capacity and broad inclusion were clearly of importance, the project\'s compliance with historical traditions and norms of medical governance stands out as the key factor in understanding the successful establishment of the priority guidelines.
摘要:
本文调查了2008年至2012年成功引入33项挪威专科医疗保健优先指南的因素。该指南是将临床优先级设置的监管从医疗专业人员的主要自我调节转变为更集中和分层形式的重要一步。因此,来自医学界的抵制是意料之中的。我的重点是制定指导方针的项目中的组织因素,以政策文件和项目文件为主要数据源。我发现该项目的特点是在组织方式和参与者方面具有高度的自主性,在结构和人员方面具有显著的行动能力,并广泛纳入受影响的行为者。优先指南项目由医疗专业人员主导,其组织并不代表与医学专业自我调节的既定传统的彻底突破。虽然组织自治,行动能力和广泛的包容性显然很重要,该项目对医疗管理的历史传统和规范的遵守是理解优先指南成功建立的关键因素。