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"The health sector is a complex and dynamic conglomerate of services at local, regional and national levels. How to balance different considerations between new medical-professional knowledge, controlling expenses and local interests are among the permanent challenges facing political bodies when planning and structuring the services. The book is based upon institutionalist organisation theories, referring back to classic texts as well as present-day analyses. By taking a long-term perspective, and analysing one Norwegian county as a case study, the author addresses questions about how conflicts on hospital structure seemingly have been solved, and how the introduction of new management forms have changed the sector.
One of the issues is how, in a 40 years' perspective, different interest groups have seen their influence over health services and management forms have changed. In contrast to hypotheses that medical doctors would see their influence becoming reduced, the analyses show how medical actors, in an alliance with management consultants, have become more influential when innovations in health work and eventually organisation models are introduced. Regional political bodies and local community interests have lost much of their former role in restructuring processes. At the end of the book, the author makes some hypotheses about how health services will develop in the interface between ideas of a centralised, modern, high tech hospital model on one hand, and local and home based services on the other. These developments will in a nearby future most likely restructure the health sector once more.
" - "Helsesektoren er i stadig endring. Utfordringene sektoren står overfor, dreier seg blant annet om å finne balansen mellom medisinsk-faglig utvikling, økonomiske rammer og geografiske hensyn. Organisasjons-, styrings- og ledelsesformer påvirker forholdet mellom disse hensynene, som ofte trekker tjenestene i ulike retninger.

Et av de mest kontroversielle spørsmålene er hvilken sykehusstruktur som er mest hensiktsmessig. De siste årene har en på ny opplevd at protestene mot sentralisering av sykehussektoren er blitt sterkere. I debatten er det igjen blitt søkelys på de helsepolitiske spill og strategier som kjennetegner sektoren. Samtidig påvirkes tjenestene hele tiden av medisinsk-teknologiske innovasjoner, nye økonomistyringssystemer og innføring av «moderne» styrings- og ledelsesformer.

I denne boken diskuteres hvordan en i Østfold håndterte utfordringene knyttet til sykehusstruktur, og hvordan det er skapt tilsynelatende ro om dette tidligere så betente spørsmålet. Forfatteren analyserer først de strategiene som førte til at sykehusdriften i fylket ble sentralisert og et nytt «supersykehus» på Kalnes ble bygget. Deretter blir noen kjennetegn ved organisasjons- og ledelsesformer i det nye sykehuset drøftet.

Avslutningsvis diskuteres de underliggende utviklingstendenser som kan peke mot fremtidens sykehustjenester innenfor et mer helhetlig «helsesystem», som også omfatter lokale helsetjenester. Analysen er basert på moderne organisasjons- og ledelsesteorier. Et sentralt spørsmål her er hvordan institusjonelle særtrekk ved sektoren har betydning for de endringene som har skjedd de siste 40 -50 årene.

Målgruppen for boken er forskere, universitets- og høgskoleansatte og studenter i samfunnsvitenskapelige fag relatert til helsesektoren. Boken vil også gi ny kunnskap til ansatte i sektoren, og andre som er opptatt av helse- og velferdspolitiske spørsmål."

This thesis studies three major reforms in the public sector of Norway. The sectors studied are the police, higher education, and primary schools. The main motive for studying these reforms are of a theoretical nature, the reason to study them is to produce general knowledge about reforms. The study aims to answer two main questions. One is about the possibilities and limitations contained in using reforms to change organizations. The second is about how organizations can promote the ideals of representative democracy. In its efforts to attain answers to these questions the thesis blends empirically-oriented research with aspects of organization theory and political theory. The thesis is divided into four different parts. First, there is a descriptive presentation of the three reforms. Secondly, there is a discussion of various theories of reforms and organizations. The primary aim of this analysis is to illuminate and explain the empirical data, but this discussion should also provide its own answers to the main questions asked in the thesis. Thirdly, these theories are applied to analyze data from the three reforms. And finally, the study concludes with a summary of what general insights about the reforms we are left with after studying the Quality Reform, The Police Reform 2000, and the Knowledge Reform. The study shows that reforms have both policy and content aspects, and that it is important to distinguish between the two in order to analyse and understand them. The policy aspect is that reforms are a strategy for change - they are tools for implementing change in organizations. The content aspect is that reforms have a specific content - they have certain objectives that they want to realize. The study concludes that in order to understand this complex and fascinating phenomenon, we need to understand reforms both as instrumental tools, institutional adaptations and symbols.