What works in Oslo might be a bust in northern Norway

The pandemic may have lowered the threshold for adopting new technology. With the coronavirus, even more grandparents than usual have been using FaceTime and Skype to connect with their grandchildren. Others have had video conversations with their GP – and some patients have even been diagnosed without having to go to a doctor’s office.

Digitization and robotic technology offer new opportunities. Robots can mow the lawn and do the vacuuming when people’s health fails them. Many older people can derive extra pleasure and benefit from technological innovations.

With the number of ageing Westerners growing at full speed, we may need to use new, so-called “welfare technology” to ease the pressure on the health care system and other parts of the public sector. But a country as geographically stretched out and diverse as Norway requires specially adapted solutions.

Oslo needs different solutions than northern Norway

“When new technology is introduced on a large scale, you can’t just assume that the same solutions can be used everywhere,” says Erlend Kleiven-Jørgensen.

He has looked at how Norwegian municipalities introduce and use new technology that is intended to help elderly residents. (See fact box for the types of technology.) The result of his study is a master’s thesis that is attracting attention among experts in the field.

“The problem is that Norway is geographically extremely spread out and diverse. What works in Grünerløkka might be ineffective in Finnmark,” says Kleiven-Jørgensen.

“We’re lucky that this shutdown and isolation happened after most people had internet services in their homes.”

Kleiven-Jørgensen wrote his master’s thesis at NTNU’s Department of Interdisciplinary Studies of Culture, and his supervisor, researcher Roger Andre Søraa, supports the findings.

Technological solutions can contribute to better everyday living. Illustration photo: Shutterstock, NTB scanpix SHOW MORE

“Norwegian municipalities have a thousand different ways of doing and not doing things. It’s important to try and get people to speak a common thematic language. It’s important to figure out together how we can best help the elderly to have good, dignified and secure lives,” Søraa says.

Søraa thinks the exciting thing about this thesis is how Kleiven-Jørgensen has followed, or shadowed, a consulting company that was set up to remedy the massive problem of the ageing population boom.

“Kleiven-Jørgensen has travelled high and low all over Norway, and especially now during the pandemic I think these ‘distance caring’ technologies that he’s investigated are very relevant,” says Søraa.

“We’re lucky that this shutdown and isolation happened after most people had acquired internet services in their homes,” he says.

What about when the Internet goes down?

In a small, spread-out municipality, digital supervision or distance follow-up could offer even more gains. The fact that residents can receive follow-up care in their homes, and that health professionals don’t have to travel long distances, are two benefits of using this technology.

“Everything is based on web solutions, but internet access out here is often subpar.  It doesn’t help us to hear how well everything works in bigger cities like Bergen and Bærum.”

Small municipalities are often more vulnerable because they have fewer resources, both financially and in the number of employees. They may have poorer telephone coverage and internet access, due to the large geographical distances.

In a spread out and sparsely populated country, the internet is not necessarily stable everywhere. Illustration photo: Shutterstock, NTB scanpi SHOW MORE

“Can they trust the technology if it depends on good coverage and internet access? What happens if the internet is down?” asks Kleiven-Jørgensen.

A project manager in a small municipality commented that they often heard glowing stories from municipalities with greater resources than they had. The project manager believes too little attention is paid to the challenges of implementing similar projects in small municipalities.

“Everything is based on web solutions, but internet access out here is often subpar. Then it doesn’t help to hear how well everything works in bigger cities like Bergen and Bærum,” he said.

At the same time, it might be easier to carry out pilot projects in smaller municipalities, where starting new initiatives doesn’t run into as much bureaucratic red tape.

Need to collaborate

When new technology is introduced, it has to be adapted to local conditions, while also maintaining an overriding national idea behind it all.

The overall national idea is that all Norwegian municipalities should be able to offer welfare technology to their inhabitants. In other words, welfare technology must be an integral part of the health and care services in Norwegian municipalities.

But this can only be achieved through interdisciplinary cooperation, not only between the state and the municipalities or between municipalities, but also within each municipality.

“One important lesson is that municipalities in general have the potential to become better at working across sectors within the municipality,” says Kleiven-Jørgensen.

Silo thinking won’t work

In some municipalities, people are used to working in their own area of expertise, where they have their own, clearly defined professional fields with working methods and ways of thinking that are particular to them — an approach called silo thinking

But Kleiven-Jørgensen believes that to solve complex problems and implement major innovations, they should work more as a unit.

“In the project I studied, for example, employees were grouped with ICT service representatives, health managers and health professionals. In a few cases, the municipal management was also represented,” he says.

The municipalities were encouraged to collaborate across functions, not only within the municipality, but also with a private consulting company.

First and foremost, implementing new technology is about the citizens who make use of the technology and the employees who have to learn to use it. Illustration photo: Shutterstock, NTB scanpix SHOW MORE

Completely necessary

Kleiven-Jørgensen points out that implementing new technology isn’t just about the health service in the municipality. “First and foremost, it’s about the residents who make use of it and the employees who have learn to use it.”

But the project also involves several segments of the municipality. For example, the technical department may be responsible for the maintenance and follow-up of the technology. The purchasing and finance department needs to be involved in large purchase. And the municipal management has to be involved in helping municipalities succeed in using the new technology.

Detailed instructions were among the tools for introducing new technology, step by step, on the Norwegian Association of Local and Regional Authorities’ websites. Workshops and consultant guidance were used extensively.

Cooperation, believes Kleiven-Jørgensen, is absolutely necessary for the elderly to gain the greatest possible benefit from the new technology and for the public sector to get the most out of their investments.

Sources: Erlend Kleiven-Jørgensen: Facilitating and Carrying out Innovation Processes in the Public Sector: Implementing Assistive Technology on a Municipal Level. NTNU / KULT 2020

Melting, J. B. (2017). Andre gevinstrealiseringsrapport med anbefalinger. [Second profit realization report with recommendations.] Oslo: The Norwegian Directorate of Health

Melting, J., & Franzen, L. (2015). Første gevinstrealiseringsrapport med anbefalinger. [First profit realization report with recommendations.] Oslo: Norwegian Directorate of Health