Implementation of the Municipal Emergency Day Care Unit in Oslo

BACKGROUND: The implementation of the Coordination Reform started in 2012. One of the reform s goals is to establish municipal emergency day care units that cover the needs of local population in municipalities. Establishment of these units is underway now or is due for completion by the year 2016. However, Oslo fully established these services in 2013 and it will be taken as a case for the research. OBJECTIVE: To examine if the implementation of the KAD in Oslo has proceeded as intended. GPs referrals to Oslo KAD are given primary focus in the research because one of the Coordination reform s goals is to reduce admissions to specialized healthcare services. More specifically, in this research I aim to understand what factors of low referral rates to Oslo KAD are as well as to compare these findings with the research results obtained from relevant staff members of Oslo KAD. Analysis of the results through implementation theory will help to explain the gap between intended and implemented KAD in Oslo. METHODS: Statistics from Oslo KAD showed that general practitioners avoid referring patients to this institution, choosing instead hospitals. Semi-structured interviews were used to examine the implementation of the Oslo KAD from this point of view. Sample in this single case study includes general practitioners in Oslo municipality, Oslo KAD and staff from emergency ward in Oslo. The data were analysed using the qualitative data analysis method by analyzing content and discussed from the Implementation theory perspective. RESULTS: The findings of the research have shown that the main factors behind the bottlenecks to implement the KAD as intended are differences between healthcare organization in Oslo in relation to the rest of Norway; challenges of providing information for GPs; logistical issues; and novelty of the Oslo KAD. The results were discussed based on implementation theory