What can Norway learn from Canada?
In Norway, the Ministry of Health and Care Services governs the regional health authorities and the Directorate of Health through annual assignment documents. However, there is no requirement for establishment of forums for joint preparation, implementation and evaluation of action plans. Thus, the Directorate of Health issues national professional guidelines, but these contain no specific information on how the hospitals should implement them in their daily operations or how compliance with them should be evaluated.
In November 2013, the Office of the Auditor General published an investigation of effectiveness and goal achievement in the Directorate of Health. The report pointed out that the Directorate fails to undertake sufficiently systematic efforts to implement its own guidelines and manuals, and that this reduces the normative effect these are intended to exert on practice in the health and care sector (18). In the Ministry of Health and Care Services’ national cancer strategy for 2013 – 2017, specific objectives for how national action plans should be implemented and their effects estimated are absent (19). In our opinion, the Ministry’s national cancer strategy ought to state that:
The Directorate of Health and the regional health authorities should jointly prepare national professional guidelines that are relevant for the ongoing treatment of patients.
The guidelines should be adapted to structured primary data entry in electronic health records.
The regional health authorities are responsible for implementing national professional guidelines in their daily activities.
The Directorate of Health and the regional health authorities have a shared responsibility for continuous evaluation of the application of national professional guidelines through the use of national quality registries linked to the Cancer Registry of Norway.
In our opinion, the example from Ontario, Canada, provides an excellent model for how this can be done.
The medical profession in Ontario (Ontario Association of Pathologists) had defined the pathology variables to be reported, and these had been accepted by Cancer Care Ontario. Thus, this decision was a consensual «bottom-up» decision. However, the medical profession had also undertaken another, quite unusual assessment. They had assessed the use of resources associated with the preparation and maintenance of the province’s quality indicators for histopathology cancer reporting. In the association’s opinion, it would be more appropriate to use equivalent indicators prepared by the College of American Pathologists. A professional collaboration was therefore launched to develop such indicators jointly. Cancer Care Ontario is granted free access to the electronic templates developed by the College of American Pathologists on an ongoing basis (20).
In Norway, the Norwegian Society of Pathology intermittently prepares professional guidelines (21). In parallel to this, the Directorate of Health produces similar national professional guidelines (22). These are not necessarily identical, and none of them are as specific and detailed as the electronic checklists produced by the College of American Pathologists.