The organizational challenges of municipal call centers as a health service in Norway-a multiple case study.

Background: To maintain sustainability in the health care system, technology such as social alarms and sensors has been implemented in people's homes with the goal of increasing independent living for elderly and multimorbid health care recipients. When implementing technology, someone needs to monitor and answer the alarms and calls, which is often coined 'telecare'. Many countries have organized telecare service in call centers, which in the health care domain is a service innovation. This study aims to research how call centers in Norway were organized, what services they offered, and what challenges they faced.

Method: This was an explorative study, using multiple case methodology. The study included five call centers, covering approximately 60 municipalities across Norway. 11 interviews with 15 informants, holding a variety of positions, such as managers, assistant managers, health personnel, technicians, advisors, and subject coordinators, call center observations and document studies were conducted. The data was analyzed inductively, and empirical literature as well as a framework for service innovation were used as theoretical perspectives.

Results: Four types of organizational structures of call centers were identified: 1) call center combined with emergency room; 2) call center combined with other technology; 3) call center combined with ambulant team and 4) call center combined with an advisory department. One factor for innovation success has been identified as market conditions which are expected to be increasing, whilst the study identified several challenges, for example the complexity of stakeholders. Based on different stakeholder worldviews, the various methods of innovation and organization have led to a variation in services.

Conclusions: Stakeholders with different worldviews, service innovation strategies and municipal autonomy have influenced how the call centers have developed in different directions. They are still in a service innovation phase, implementing new services and technology. The call centers appeared to be 'caught between a rock and a hard place' - situated between health and social care, but slowly moving towards acute and contingency services, that is, from telecare towards telehealth.