Municipalities embrace radical innovation to cope with an ageing population

In 2030, there will be more elderly people than children in many countries and regions in Europe. The increased ageing population and the shortage of health personnel mean that the municipalities have to make major adjustments in order to be able to deliver health and care services to everyone.

The warning lights have been flashing for years without many municipalities having developed strategies to prepare for the wave of elderly people.

A crisis foretold

Increasingly, it seems that we are already witnessing a municipal collapse, especially in the rural areas. It particularly affects the oldest and most vulnerable citizens, who are in great need of help and care. But it also has negative consequences for people of all ages who depend on assistance from the public sector.

There has been no shortage of debates, letters from readers, public investigations or national and local politicians who have looked worriedly at the red numbers in Excel.

The significant challenge in the health and social care sector is what we call a thoroughly foretold crisis.

Digitalisation in health and care

The municipalities are responsible for providing good and safe services for everyone. This means that the municipalities are also in the driver's seat to facilitate innovation, change and skills development.

But they can't do it alone. They must cooperate with each other and with other stakeholders in society. And the work has begun.

“There is a lot happening in the field of digital health. Digitalisation in health and care is a key component. It is very important since the municipalities have tight finances and problems recruiting caregivers. We emphasize the citizen's perspective. This means that the services must be holistic, coordinated and coherent,” Kristin Standal says.

She is the subject specialist and project manager for assistive technologies and remote care at KS – The Norwegian Association of Local and Regional Authorities.

With a background as a nurse and with a master's degree in health informatics, she is well suited to identify barriers and solutions together with the partners.

Communities must use the technology

She says that in 2022 they created the document Municipal sector's ambitions in the e-health area, which is a common framework. It has been written in close collaboration with the municipalities and with input from national and regional health authorities and advocacy organisations.

The plan emphasises good cooperation between the national authority and local governments and identifies five priority areas: citizen services, pharmaceuticals, assistive technologies and remote care, joint e-health solutions and digital collaboration.

“A return on investments will only be seen when the municipalities have utilised the technology to change and improve their work processes,” Standal says.

A common national system is missing

And it's not easy. This is partly because the development of technology, services and regulations for the municipalities are not aligned.

There is still no national, functioning digital solution for interaction, which provides access for healthcare personnel in primary or specialist healthcare.

KS and the national health authorities want the municipalities to adopt assistive technologies and remote care on a large scale. The technology and knowledge must reach everyone.

Remote care and monitoring involves patients using technology to share their health data with primary healthcare providers or the hospital. This applies in particular to people with chronic conditions. In this way, healthcare personnel can track health trends over time and facilitate earlier interventions.

This means that people do not have to show up in person for repeated check-ups with the doctor if it is not necessary.

“We have established a network that will assist the municipalities in their implementation of assistive technologies and remote care. We encourage all municipalities to choose a contact person who ensures good information flow, so that everyone gets an insight into the activities,” she says.

Scientists will study effects

Digitalisation networks have been established in the country's regions. They will coordinate the work.

The responsible persons all have experience with the introduction of assistive technologies, and it is municipalities and county councils that hold the steering wheel.

Scientists will look at the results of digital home monitoring.

“We want to study what happens during the introduction, and what effects it has on the patient's health and well-being, use of healthcare services and costs over time,” says Siri Bjørvig, head of Personal E-health at the Norwegian Centre for E-health Research.

The researchers will use various research methods to collect and analyse the available data. It will help to strengthen the knowledge base about the importance of and models for digital home monitoring.

Must see the big picture

KS has taken several measures in order to be an important support for the municipalities in their change processes.

One move is to create a program they call Partnership for radical innovation. Here, actors collaborate across professional fields, sectors and administrative levels.

Those who deal with the problems only from their own perspective often find that it becomes difficult. While those who are able to work interdisciplinary and see the whole, have a good chance of building new, sustainable services. A comprehensive look at the use of technology, services and processes will challenge existing structures and cultures in health and social care.

More effort is needed

Many municipalities are already experiencing difficulties in retaining and recruiting health staff. At the same time, the health and social care budgets are under pressure, says Henrik Dons Finsrud, subject leader for insight and innovation at KS.

He says we cannot expect the health and welfare sector to be able to solve the challenges alone.

“People are living longer, and more people need help. There are not enough staff to carry out the tasks as they are today,” says Finsrud.

He praises communities that have rolled up their sleeves. Some have developed their village centre.

Instead of the home care workers driving to each resident’s home, the seniors are bussed to a health and service centre. There, they can get help and various offers, such as an appointment with a doctor or physiotherapist, socialise or visit a cafe. It will be a gain for the user, the service provider and society.

Digitalisation and better use of health personnel point to some answers. But more needs to be done.

“It is about promoting safety, belonging, trust and health. How can we design welfare in new ways, which require fewer people? We need community development on all levels,” Finsrud says.

“The future tool” to understand

Innovation work is not least about creating a shared understanding of what the problems are. It is not enough that the authorities have described it.

Health workers, managers and residents in cities and in the countryside should all be well informed about the realities and what will be required decades from now.

In KS' Future Toolkit 2040, people can check for themselves how prepared they and their municipality are. The aim of the online tool is to help citizens understand what choices they can make for the place where they live.

The tool consists of three parts: One part gives you the overview of the country. The next part gives a status for your municipality and shows the development towards 2040. You can then explore different options for the future.

“We hope that many will use the resource, and that it can be particularly useful for the country's municipal councils,” says Finsrud.

Leaders must drive change

It is important to have knowledgeable and determined managers in the right place when technology is introduced, and organisations need to change.

In research on change and change management, the conclusion is often that a solid toolbox and the right personal qualities are required to handle challenges. Furthermore, managers are often unsure of what can be done with culture that "sits in the walls".

“Middle managers are often key in a change journey. They must lead, motivate and prioritise. We see a great need for competency-building in those areas. For example, not all department heads have management training. Perhaps they completed nursing school a long time ago and got their managerial role because they were professionally skilled or could no longer do rotating shifts. In addition, they have a busy working day with responsibility for many other tasks,” says Kristin Standal.

KS is starting a research and development project to find out what kind of competence managers need to drive change.

“Many municipalities are doing well and have already found creative solutions. They have gained an understanding of what it takes to succeed. Those who meet and share their experiences in the networks learn the most and the fastest. We spread the success stories and also remind everyone that we learn a lot from hearing about the not always perfect first attempts,” says Standal.

Read the Norwegian version of this article on Forskning.no.