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Norway's eHealth governance model faced challenges in balancing government authority and stakeholder autonomy. Diminishing trust and transparency issues hindered the inclusive approach, impacting policy legitimacy.

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Area of Science:

  • Public Health Policy
  • Digital Health Governance
  • Health Services Management

Background:

  • Governments struggle to balance hierarchical steering and horizontal governance with fragmented decision-making.
  • Norway established an eHealth board for its One Citizen-One Journal policy to align stakeholder interests with government ambitions.
  • Empirical knowledge on developing inclusive governance models is limited.

Purpose of the Study:

  • To investigate the development of Norway's inclusive eHealth governance model.
  • To analyze how the model aligned government policy ambitions with stakeholder concerns from 2012-2022.

Main Methods:

  • A thematic analysis of 16 policy documents and 175 consultation responses (2012-2022).
  • A constructivist research approach using deductively derived governance and public governance theory themes.
  • Interpretation, analysis, and synthesis of findings.

Main Results:

  • The policy implementation involved 3 phases, marked by shifts in stakeholder inclusion and influence.
  • A conflict emerged between top-down government authority and stakeholder autonomy, particularly between health organizations and patient groups.
  • Governmental insensitivity, lack of transparency, and declining trust eroded the legitimacy of the inclusive governance model.

Conclusions:

  • Norway's One Citizen-One Journal policy evolved through 3 phases with contrasting stakeholder perspectives.
  • Diminishing trust in the inclusive governance model was a key outcome.
  • Challenges in participation, transparency, and trust creation impeded the National eHealth Governance Board's legitimacy, highlighting obstacles for inclusive governance models.