Doctor with a strategy

Carl Fredrik Dalaker is a doctor of medicine with a master's degree in strategic management from the Norwegian School of Economics (NHH). This double degree gave him the professional competence he needed to realise his plans for a health park. The goal is improved and much more efficient treatment of patients in Bergen.

26.03.2012 - Sigrid Folkestad

It is Friday morning at a doctor's surgery in the Nordnes area of Bergen. All the chairs in the waiting room are taken - by young and old patients, pale and quiet. The medical secretary is busy on the phone. When new patients enter, everyone looks up from their magazine or newspaper.

Doctor Carl Fredrik Dalaker is waiting in the lunch room. Every Friday he takes time off from his job as a general practitioner to devote time to realising the project and work on ideas for better coordination of the health service. He has been working on the Ispoli Helse project for several years. Now the funding is in place, and Bergen could soon be the first place in Norway to have a health park of this kind. A building where GPs, specialists, physiotherapists, chiropractors and homoeopaths can be gathered under one roof, under a joint strategic management aimed at achieving a common goal: better and swifter treatments, and patients with less sickness absence.

'This is not a private health initiative aimed at maximising profit. This solution is different. It is possible to be a private player with a different philosophy that is based on taking more social responsibility and developing concepts rather than on making a profit,' says Dalaker.

Dalaker qualified as a doctor in 2001. Six years later, he had completed MASTRA, an Executive MBA programme in strategic management at NHH. During these years, he worked on the idea for the Ispoli Helse project.

Value workshop in Bergen

'Ispoli Helse will be a value workshop where people from different disciplines are gathered under a joint strategic management. In a health building housing many different professions, we can cooperate to arrive at a shared understanding, identify appropriate measures and carry out treatment far more quickly and in a better way than when all the health professions are scattered, as they are in today's system.'

When Dalaker started working as a GP, he saw some things that he reacted strongly to.

'If you go to your doctor with heart problems, they will roll out the red carpet for you. There is no limit to the resources that are made available. Everything is laid on for high-status diseases,. But if patients come in with psychiatric or substance abuse problems, you have to fight for each patient,' says Dalaker. 'They are often life threateningly ill, and many of them are very young and have very complex problems.'

'The first line service is extremely fragmented, and there is no structure that ensures that doctors can collaborate well with physiotherapists, chiropractors, pharmacies or social security offices. They work in isolation from each other. This means that patients have to go from one provider or agency to another. This moving around is highly dysfunctional.'

'This might work all right for a thirty-year-old patient, but not for elderly patients or patients with complex needs that make it hard to navigate this fragmented structure. This generates unnecessary sickness absence,' says Dalaker.

'When you come to me and are referred to a physiotherapist, it takes a week or two before you get an appointment and are actually treated. If you have complaints at work and have arm and shoulder pains, you go to your GP and argue that you can't go to work. This moving between different health care providers alone can lead to a prolonged sickness absence.'

Will not have to pay more

His experience from his doctor's practice in Bergen made Dalaker realise that the collocation of services under a common professional management would be much more flexible, because the professionals could talk to each other, cooperate both formally and informally and do their job within a professional operating framework. And all of this with one common goal: to make things easier for patients.

'If collocation is to succeed, you have to look at and know about the incentives that apply to GPs, physiotherapists and other professionals in the first line health service. We like to be independent and in control of our own finances. That is why we choose the first line service, while those with other interests and who are wired differently are drawn to the hospitals. You have to understand this if you are to succeed in achieving efficient collocation. Otherwise, the result will be health parks established using coercive methods.'

Dalaker and the project group that have worked on Ispoli Helse believe they have solved this problem, while at the same maintaining all important incentives and underlying motivational drivers for the professionals that are invited to join. It will result in an improved and more efficient health service without costing the municipalities anything extra.

'Many healthcare units are run quite inefficiently and unprofessionally. We are trained as doctors of medicine, not business managers. When we join forces under one roof, the professionals will have more time at their disposal and can choose whether they want to spend it on more free time for themselves or on seeing more patients, which will increase their earnings.'

This is the coordination reform in practice, says Dalaker. Formally, people's access to the health park's services will be the same as for corresponding health services today. The gains achieved through collocation and coordination will benefit patients, treatment providers and society as a whole.

Substance abuse patients

The idea for a health park came as a result of Dalaker's experience as a GP, and especially from his dealings with substance abuse patients.

'I was just shuttling patients from one specialist to the next. The way the system was designed was shocking.'

These are patients with general medical problems, social problems, psychiatric problems and addiction problems. Patients are passed between treatment providers and have to attend several appointments in several different places. That is more than many can manage. This results in a selection process whereby healthy people come for treatment, while sick people are labelled 'not motivated'.

'I had some ideas about this, but found out that I had to learn more if I wanted to take it further. I wanted to learn more about management and organisation in order to improve the basis for my professional practice. I started taking short courses of study in management at NHH, but realised that that wasn't going to be enough. I then decided on the MASTRA programme, as that would give me the professional competence I needed.'

NHH's initiative

Dalaker is very satisfied with what he learned from his Executive MBA programme and believes that universities and companies should learn from NHH and focus more on programmes of this type , i.e. programmes that are adapted to students who already have a certain formal competence and some years' work experience.

In May 2007, the university and university college sector appointed an independent Bildung Committee - on the cultured perspective in higher education (Dannelsesutvalget) - to examine how the cultured perspective is addressed in higher education. Dalaker finds this interesting.

'It is about becoming better at reflecting on issues that do not fall within our own field of expertise. And it is about being inquisitive and seeing several disciplines and professions in conjunction with each other, and continuously assessing and reflecting on how competence can fit in with and be further developed in cooperation with the society we are part of. In my opinion, this is about how information is communicated and about the teaching and organisational culture within which it is communicated. Information can be planted in an authoritarian way and be framed by protective cultural walls, or it can be embedded in a continuous lifelong cycle where information and experience are shared and transformed into new knowledge in an open, reflective process. The latter is something educational institutions should strive towards,' Dalaker concludes.

Carl Fredrik Dalaker is a doctor medecine with a master's degree in strategic management from the Norwegian School of Economics (NHH).

Foto: Helge Skodvin