Failed project management
The task that the Directorate of Health undertook – to develop and implement the Norwegian Laboratory Coding System – is particularly demanding and complex. No country has previously introduced a mandatory, shared laboratory coding system that encompasses all the laboratory sciences. This type of pioneering work requires good planning, solid endorsement by the health enterprises, a generous schedule, regular and close follow-up, qualified advisors, adequate information flow, high professional ambitions, careful interdisciplinary coordination among the sciences, good quality control, and the ability and willingness to listen to input from those involved. Unfortunately, the Directorate of Health has fallen short on all these points in its management.
The international coding system that was used as a basis and which the authorities wished to introduce in Norway was primarily developed for medical biochemical analyses (6). It was not designed for other laboratory specialties, Norwegian language or Norwegian laboratory tradition. The professional communities called attention to this challenge at an early stage, and reiterated this criticism when the first version of the coding system was published in 2013 (7). They recommended that the Directorate of Health enlist expertise from the six laboratory sciences to coordinate a structured review with professional and linguistic systemisation of the Norwegian Laboratory Coding System and that a generous and realistic schedule for this work be drawn up (7, 8). This advice was not followed. On the contrary, the coding system was made mandatory and was to be implemented at a time when it was far from complete, whether for professional, technical or economic purposes (5).
This disregard of the input from the professional community has unfortunately been a recurring theme in the project management of the Norwegian Laboratory Coding System. The same thing occurred when the Directorate of Health promised the professional communities that it would take charge of developing an interdisciplinary table of analytical methods that would detail the differences in results when the same analysis was performed using different methods (9) – (11). This entire project was suddenly shelved with no justification (12) – (14), contrary to a unanimous recommendation from the professional communities. The consequence of this action is that we now have a coding system that cannot be used for a sound economic reimbursement scheme (15, 16), but which unfortunately the Directorate of Health nevertheless plans to use for this purpose (17).
The trust of the professional communities in the Directorate for eHealth as the coding system administrator has been severely undermined by these matters and many more of a similar nature.