Managing integrated care – experiences form developing a digital pathology network

Introduction: Sweden is currently facing a great lack of pathologists and therefore a shortage of competence and capacity for daily diagnostics and for training new pathologists. This shortage, found both in the labs and in the diagnostic process, impose several challenges to the pathological care in Sweden, e.g. restricted cancer care processes, extended lead times, and poor quality. In 2015, a digital network model for expert diagnostics based on collaboration between disciplines, activities and regions was developed and implemented nationally. There is scarce research on how this kind of integrated care collaborations can be managed and developed. By studying this network model, the research aims to develop the current “best practice” and inform how to optimally manage project aimed for integrated care.Theory/Methods: The theoretical framework of this study was guided by research on project administration and change management. The initial stage of the project aimed to develop a digital network model for expert diagnostics. The development work was organized as a pilot study where county councils, hospitals, research institutes and private companies were involved (9 stakeholders). The second stage of the project focused on the implementation process, and reported below is the findings from an interview study with the participating representatives in the project group and the steering committee during the implementation process.Results: The results show a range of challenges associated with successful project management, organizational development, and network-based services. Characteristically, the participants' described the project as relevant, but challenging in releasing time for project activities, and unclear expectations on the project team's role and efforts. The results also depict a project in constant change regarding goals and performance putting demands on perceptive management.Discussion: The discussion involves issues on the challenges depicted in the study and how they can be understood and managed. The challenges can to a large extent be understood as effects of different stakeholder (organisational) logics, with e.g. different time perspectives and government structures. Since the interests and priorities evolve over time, often in diverse manners, the management should have an agile mind set meeting the project needs in different phases.Conclusion: Extended initiatives to establish shared expectations and agreements between all stakeholders concerned – a central condition for long-term individual project commitment – were needed.Lessons learned: While previous research recognizes the importance of a shared project vision, insights from this case of an integrated network also underline need for project administrators and managers to continually balance new inputs, interests and priorities as the project evolves.Limitations: The study was limited in collecting interview data from a limited number of project participants. Additional interviews with e.g. different stakeholder representatives would have a provided a more detailed project picture.Suggestions for future research: Further research is needed on project cooperation between different types of stakeholders in order to develop efficient integrated care

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