raki

• Oksavik, Jannike Dyb & Kirchhoff, Ralf (2026). Views on task shifting implementation in Norwegian health policy and among health service managers – a mixed methods study. BMC Health Services Research. doi: 10.1186/s12913-026-15740-3. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Introduction The World Health Organization promotes task shifting to enhance access and efficiency in health systems and mitigate the shortage of health professionals. Such global recommendations are adapted to national health policies and are to be implemented in local contexts. The Norwegian government propose guidance for task shifting, and implementation largely depends on the views and practices of health service managers. This study includes the views on task shifting in Norwegian health policy and among health service managers, asking; what are the responsibilities of managers in implementation, and what actors should they include in task shifting? Methods A mixed‑methods approach captured both the guidance in health policy documents and the situated views among managers. The qualitative part was analysis of guidance on task shifting in three Norwegian health policy documents from 2023 to 2024: a white paper, an Official Norwegian Report, and an operationalization of hospital waiting times reduction. In September 2024, we conducted a cross-sectional study in Western Norway, including 139 health service managers. The documents were analyzed by content analysis, and the survey by descriptive statistics and correlation analysis. Results More task shifting was endorsed both in the policy documents and among managers. The government recommended building competences at the bottom levels of the workforce, primarily among skilled workers. Task shifting could also include technology, patients and non-governmental organizations. Most of the health service managers focused on utilizing competencies at the top levels of the workforce, e.g. by shifting tasks from physicians to nurses. The policy recommended three areas of managerial responsibilities: strategic competency planning, patient safety and leading staff. To managers, strategic competence planning was done annually, patient safety was less salient, while leading staff were important. Managers were positive overall about implementing task shifting despite organizational challenges. Discussion/conclusions The views on task shifting in policy documents and among managers differed on what actors to include. Being in the early stage of the implementation process may explain why the managerial areas of responsibility were less prominent in the managers’ responses. However, views were overall positive towards involving multiple actors more than today.

• Liepelt, Silje; Sundal, Hildegunn & Kirchhoff, Ralf (2026). Exploring a root cause analysis team's experience with involving patients and next of kin after a sentinel event. Frontiers in Health Services. 6. doi: 10.3389/frhs.2026.1825372. Fulltekst i vitenarkiv Vis sammendrag

  Background There is a growing recognition among healthcare providers and policymakers of the importance of involving patients and their next of kin in root cause analysis (RCA) to improve patient safety and healthcare quality. However, such involvement is intricate and challenging. This study explored how the involvement of patients and next of kin influenced the RCA team's understanding of a fatal sentinel event in maternity care. Method The study was a qualitative exploratory single-case study combining document analysis with interviews with six RCA team members. The selected case came from a Norwegian hospital responding to a sentinel event involving the unexpected death of a child during childbirth. The study addressed the following research questions: What were the team's experiences of involving patients and next of kin in the RCA process? Data collection included twelve interviews with six RCA team members, which were analysed using reflexive thematic analysis. Results Four main themes were identified. These concerned: (1) uncertainty regarding whether bereaved parents should be involved in the RCA process; (2) challenges associated with conducting interviews with the parents; (3) incorporation of patient and next-of-kin perspectives into the RCA report; and (4) the RCA team's learning process following involvement of the parents. Conclusion The findings suggest that involving patients and next of kin in RCA processes may contribute perspectives that strengthen organisational learning and understanding of sentinel events. Future research should explore how RCA frameworks can be systematically adapted to accommodate the involvement of bereaved relatives across different healthcare contexts.

• Frisvoll, Inger Cecilie; Aarseth, Turid & Kirchhoff, Ralf (2026). Hvordan bestemmes tidspunkt for overføring av pasienter fra spesialist- til kommunehelsetjenesten? Observasjoner fra medisinske sengeposter. I Alteren, Johanne; Hvattum, Lars Magnus; Oskars, Trond Roger; Straume, Solveig & Teryokhin, Sergei (Red.), Tid. Fjordantologien 2026. Scandinavian University Press (SCUP). ISSN 9788294167364. s. 71–95. doi: 10.18261/9788294167371-26-04. Fulltekst i vitenarkiv Vis sammendrag

  Studien undersøker utskrivningsvurderinger i spesialisthelsetjenesten gjennom observasjoner på to medisinske sengeposter. Arbeidet er informert av institusjonelle logikker som teoretisk rammeverk, og løfter frem hvordan forståelsen av tid varierer logikkene imellom. Logikkene beskrives «nedenfra» ved å se hvordan leger og sykepleiere gjennom samtaler og handlinger vurderer hva som er riktig tidspunkt for å overlate pasienten til kommunal oppfølging.

• Liepelt, Silje & Kirchhoff, Ralf (2025). Hospital managers’ experiences of conducting a root cause analysis: a case study following a sentinel event. Frontiers in Health Services. 5. doi: 10.3389/frhs.2025.1566335. Fulltekst i vitenarkiv
• D'Angelo, Egidio Niclas; Kirchhoff, Ralf & Halvorsen, Kristin (2025). Legitimizing incapacity: discursive choices in Norwegian sickness certificates. BMC Health Services Research. 25. doi: 10.1186/s12913-025-12902-7. Fulltekst i vitenarkiv
• Oksavik, Jannike Dyb; Vik, Erlend & Kirchhoff, Ralf (2024). Digital leadership : Norwegian healthcare managers’ attitudes towards using digital tools. Digital Health. 10, s. 1–8. doi: 10.1177/20552076241277036. Fulltekst i vitenarkiv Vis sammendrag

  Background: Health services are undergoing digitalization and applying new digital tools. These changes may provide healthcare managers with opportunities to exercise digital leadership. However, managers’ attitudes may influence the extent to which they demonstrate digital leadership. This study explores the attitudes of Norwegian healthcare managers towards: (1) digital tools and change and (2) to what extent digital tools are applicable to various tasks of managers. Methods: Cross-sectional study including 154 managers in hospitals and municipal health services in a Norwegian county. The questionnaire was about management and digital tools, and the data was analyzed by descriptive statistics, correlations, and content analysis. Results: The healthcare managers perceived that digital tools facilitated a positive change in organizational work processes aligned with values and goals. Digital tools supported administrative tasks such as gaining control over responsibilities. However, 76 managers stated that certain tasks, including interactions with employees (e.g. performance appraisals and sick leave follow-up) and the building of an organizational culture, should not be performed using digital tools or using them only to a limited extent; for these tasks, they preferred in-person meetings. Discussion: Norwegian healthcare managers’ attitudes toward digital tools are generally positive, but there are areas where they find the tools less suitable. Conclusions: The results provide new insights into healthcare by indicating that many managers may have positive attitudes toward digital tools. However, digital leadership may not be applicable equally in all areas of healthcare managers’ work. This raises the question of whether digital leadership can or should be exercised uniformly in every area of health services.

• Djupvik, Alf Roger; Aarseth, Turid & Kirchhoff, Ralf (2024). Profesjonsbyråkrati, styringsparadigmer og lederroller i endring. I Kirchhoff, Ralf; Vik, Erlend & Ødegård, Atle (Red.), Helseledelse : om utfordringer og lederroller i endring. Fagbokforlaget. ISSN 9788245037081. s. 25–47. Fulltekst i vitenarkiv
• Oksavik, Jannike Dyb & Kirchhoff, Ralf (2024). Hvordan opplever ledere i sykehus egen kompetanse? I Kirchhoff, Ralf; Vik, Erlend & Ødegård, Atle (Red.), Helseledelse : om utfordringer og lederroller i endring. Fagbokforlaget. ISSN 9788245037081. s. 72–84. Fulltekst i vitenarkiv
• Kirchhoff, Ralf; Bøyum-Folkeseth, Linda & Oksavik, Jannike Dyb (2024). Tilsynsperspektivet på ledelse innen tvungen somatisk helsehjelp. I Kirchhoff, Ralf; Vik, Erlend & Ødegård, Atle (Red.), Helseledelse : om utfordringer og lederroller i endring. Fagbokforlaget. ISSN 9788245037081. s. 105–128. Fulltekst i vitenarkiv
• Rødal, Jorunn; Hansson, Lisa & Kirchhoff, Ralf (2024). Standardisering og variasjon i kommunale forskrifter for tildeling av langtids sykehjemsplass. Tidsskrift for omsorgsforskning. ISSN 2387-5976. 10(2), s. 138–155. doi: 10.18261/tfo.10.2.10. Fulltekst i vitenarkiv Vis sammendrag

  Norske kommuner skal ha forskrifter med kriterier for tildeling av langtids sykehjemsplass. Det kan tenkes at lokal autonomi og variasjon mellom kommunene kan gjenspeiles i forskriftene. Kunnskap om innholdet i forskriftene er derfor et viktig bidrag i diskusjonen om likhet og rettferdighet i tildeling av helse- og omsorgstjenester. Vi gjorde en innholdsanalyse av forskriftene med et mixed methods-design. Standardisering og variasjon ble undersøkt gjennom en plagiatanalyse av teksten i forskriftene. Vi brukte det metateoretiske perspektivet institusjonelle logikker og teorier om handlingsrom til å undersøke innholdet i logikkene. Det er noe standardisering, men i hovedsak variasjon i forskriftene innad i fylkene og nasjonalt. Vi identifiserte en medisinsk/faglig logikk (80 prosent av kommunene), en New Public Management-logikk (to tredjedeler av kommunene) og en hjemstedslogikk (en tredjedel av kommunene). Det er også variasjoner innad i logikkene, for eksempel i beskrivelser av behandling av ektefelle. Svært detaljerte forskrifter begrenser tjenesteutøvernes handlingsrom i tildeling av langtids sykehjemsplass, og variasjonen kan påvirke likhet og rettferdighet i praksis. Stor innholdsmessig variasjon i forskriftene og dominans av ulike institusjonelle logikker kan utfordre hvordan nasjonale prioriteringskriterier blir brukt.

• Solberg, Mads; Kirchhoff, Ralf; Oksavik, Jannike Dyb & Wessel, Lauri Kristian (2024). Organizing visions for data-centric management: how Norwegian policy documents construe the use of data in health organizations. Journal of Health Organisation and Management. ISSN 1477-7266. ahead-of-print. doi: 10.1108/JHOM-12-2023-0378. Fulltekst i vitenarkiv
• Solberg, Mads & Kirchhoff, Ralf (2023). Media Representations of Healthcare Robotics in Norway 2000-2020: A Topic Modeling Approach. Social science computer review. ISSN 0894-4393. doi: 10.1177/08944393231212251. Fulltekst i vitenarkiv
• Liepelt, Silje; Sundal, Hildegunn & Kirchhoff, Ralf (2023). Team experiences of the root cause analysis process after a sentinel event : a qualitative case study. BMC Health Services Research. 23(1). doi: 10.1186/s12913-023-10178-3. Fulltekst i vitenarkiv Vis sammendrag

  Background: Root cause analysis (RCA) is a systematic approach, typically involving several stages, used in healthcare to identify the underlying causes of a medical error or sentinel event. This study focuses on how members of a Norwegian RCA team experience aspects of an RCA process and whether it complies with the Norwegian RCA method. Method: Based on a sentinel event in which a child died unexpectedly during childbirth in a Norwegian hospital in 2021, the following research questions are addressed: 1. What was the RCA team’s experience of the RCA process? 2. Was there compliance with the Norwegian RCA method in this case? A case study was chosen out of the desire to understand complex social phenomena and to allow in-depth focus on a case. Results: The result covered three main themes. The first theme related to the hospital’s management system and aspects of the case that made it challenging to follow all recommendations in the Norwegian RCA guidelines. The second theme encompassed external and internal assessment. The RCA team was composed of members with methodological and medical expertise. However, the police’s involvement in the case made it complex for the team to carry out the process. The third and final theme covered intrapersonal challenges RCA team members faced. Team members experienced various challenges during the RCA process, including being neutral, dealing with role-related challenges, grappling with ambivalence, and managing the additional time burden and resource constraints. As anticipated in the RCA guidelines, the team’s ability to remain neutral was tested. Conclusion: The findings of this study can help stakeholders better comprehend how an inter-professional RCA teamwork intervention can affect a healthcare organization and enhance the teamwork experience of healthcare staff while facilitating improvements in work processes and patient safety. Additionally, these results can guide stakeholders in creating, executing, utilizing, and educating others about RCA processes.

• D'Angelo, Egidio Niclas; Hara, Karen Walseth; Halvorsen, Kristin & Kirchhoff, Ralf (2023). General practitioners’ description of functioning in sickness certificates. Social Sciences & Humanities Open (SSHO). 8(1). doi: 10.1016/j.ssaho.2023.100676. Fulltekst i vitenarkiv Vis sammendrag

  In Norway, general practitioners (GPs) are the gatekeepers who provide written assessment of patients' functional ability to provide documentation for the Norwegian Labor and Welfare Administration for decisions about welfare benefits. This article investigates the description of functioning in sickness certificates according to the bio-psycho-social model described in WHO's International Classification of Functioning, Disability and Health (ICF). In particular, the study focuses on medical sick notes for young patients with common mental disorders. Methods This study utilized directed content analysis, where codes were defined a priori. A simplified bio-psycho-social model with ICF as a framework was used to categorize functional assessment. 393 sick notes were analyzed in Norway between January 2018–January 2020. Results The results show that more than half (50.4%) of the certificates contain no information about function on any level, and that the diagnosis was the only indication of a patient's function. The biological perspective was the most common description in 39,9% of the certificates, 13,5% had a description of the patient's functioning from an individual perspective. The social perspective was only adopted in 12.0% of certificates. Only 4 certificates (1.0%) described all three perspectives (biological, individual, and social) and mentioned what the individual could do despite the illness (resources). Conclusions We find that information on functional ability is limited on sickness certificates in Norway. The descriptions given were mainly from the biological perspective and without social context, which is consistent with prior research.

• Oksavik, Jannike Dyb; Solbjør, Marit; Kirchhoff, Ralf & Sogstad, Maren Kristine Raknes (2021). Games of uncertainty: the participation of older patients with multimorbidity in care planning meetings - a qualitative study. BMC Geriatrics. 21. doi: 10.1186/s12877-021-02184-z. Fulltekst i vitenarkiv Vis sammendrag

  Background Active patients lie at the heart of integrated care. Although interventions to increase the participation of older patients in care planning are being implemented in several countries, there is a lack of knowledge about the interactions involved and how they are experienced by older patients with multimorbidity. We explore this issue in the context of care-planning meetings within Norwegian municipal health services. Methods This qualitative study drew on direct observations of ten care-planning meetings and an interview with each patient right after the meeting. Following a stepwise-deductive induction approach, the analysis began inductively and then considered the interactions through the lens of game theory. Results The care-planning interactions were influenced by uncertainty about the course of the disease and how to plan service delivery. In terms derived from game theory, the imaginary and unpredictable player ‘Nature’ generated uncertainty in the ‘game’ of care planning. The ‘players’ assessed this uncertainty differently, leading to three patterns of game. 1) In the ‘game of chance’, patients viewed future events as random and uncontrollable; they felt outmatched by the opponent Nature and became passive in their decision-making. 2) In the ‘competitive game’, participants positioned themselves on two opposing sides, one side perceiving Nature as a significant threat and the other assigning it little importance. The two sides negotiated about how to accommodate uncertainty, and the level of patient participation varied. 3) In the ‘coordination game’, all participants were aligned, either in viewing themselves as teammates against Nature or in ascribing little importance to it. The level of patient participation was high. Conclusions In care planning meetings, the level of patient participation may partly be associated with how the various actors appraise and respond to uncertainty. Dialogue on uncertainty in care-planning interventions could help to increase patient participation.

• Oksavik, Jannike Dyb; Aarseth, Turid; Solbjør, Marit & Kirchhoff, Ralf (2021). 'What matters to you?' : normative integration of an intervention to promote participation of older patients with multi-morbidity - a qualitative case study. BMC Health Services Research. 21, s. 1–15. doi: 10.1186/s12913-021-06106-y. Fulltekst i vitenarkiv Vis sammendrag

  Background: Interventions in which individual older patients with multi-morbidity participate in formulating goals for their own care are being implemented in several countries. Successful service delivery requires normative integration by which values and goals for the intervention are shared between actors at macro-, meso- and micro-levels of health services. However, health services are influenced by multiple and different institutional logics, which are belief systems guiding actors’ cognitions and practices. This paper examines how distinct institutional logics materialize in justifications for patient participation within an intervention for patients with multi-morbidity, focusing on how variations in the institutional logics that prevail at different levels of health services affect vertical normative integration. Methods: This qualitative case study of normative integration spans three levels of Norwegian health services. The macro-level includes a white paper and a guideline which initiated the intervention. The meso-level includes strategy plans and intervention tools developed locally in four municipalities. Finally, the micro-level includes four focus group discussions among 24 health professionals and direct observations of ten care-planning meetings between health professionals and patients. The content analysis draws on seven institutional logics: professional, market, family, community, religious, state and corporate. Results: The particular institutional logics that justified patient participation varied between healthcare levels. Within the macro-level documents, seven logics justified patients’ freedom of choice and individualization of service delivery. At meso-level, the operationalization of the intervention into tools for clinical practice was dominated by a state logic valuing equal services for all patients and a medical professional logic in which patient participation meant deciding how to maintain patients’ physical abilities. At micro-level, these two logics were mixed with a corporate logic prioritizing cost-efficient service delivery. Conclusion: Normative integration is challenging to achieve. The number of institutional logics in play was reduced downwards through the three levels, and the goals behind the intervention shifted from individualization to standardization. The study broadens our understanding of the dynamic between institutional logics and of how multiple sets of norms co-exist and guide action. Knowledge of mechanisms by which normative justifications are put into practice is important to achieve normative integration of patient participation interventions.

• Oksavik, Jannike Dyb; Kirchhoff, Ralf; Sogstad, Maren Kristine Raknes & Solbjør, Marit (2020). Sharing responsibility: Municipal health professionals' approaches to goal setting with older patients with multi-morbidity - a grounded theory study. BMC Health Services Research. 20(141). doi: 10.1186/s12913-020-4983-3. Fulltekst i vitenarkiv Vis sammendrag

  Background Recent health policy promoting integrated care emphasizes to increase patients’ health, experience of quality of care and reduce care utilization. Thus, health service delivery should be co-produced by health professionals and individual patients with multiple diseases and complex needs. Collaborative goal setting is a new procedure for older patients with multi-morbidity. The aim is to explore municipal health professionals’ experiences of collaborative goal setting with patients with multi-morbidity aged 80 and above. Methods A qualitative study with a constructivist grounded theory approach. In total twenty-four health professionals from several health care services in four municipalities, participated in four focus group discussions. Results Health professionals took four approaches to goal setting with older patients with multi-morbidity: motivating for goals, vicariously setting goals, negotiating goals, and specifying goals. When ‘motivating for goals’, they educated reluctant patients to set goals. Patients’ capacity or willingness to set goals could be reduced, due to old age, illness or less knowledge about the health system. Health professionals were ‘vicariously setting goals’ when patients did not express or take responsibility for goals due to adaptation processes to disease, or symptoms as cognitive impairment or exhaustion. By ‘Negotiating goals’, health professionals handled disagreements with patients, and often relatives, who expected to receive more services than usual care. They perceived some patients as passive or having unrealistic goals to improve health. ‘Specifying goals’ was a collaboration. Patients currently treated for one condition, set sub-goals to increase health. Patients with complex diseases prioritized one goal to maintain health. These approaches constitute a conceptual model of how health professionals, to varying extents, share responsibility for goal setting with patients. Conclusions Goal setting for patients with multi-morbidity were carried out in an interplay between patients’ varying levels of engagement and health professionals’ attitudes regarding to what extents patients should be responsible for pursuing the integrated health services’ objectives. Even though goal setting seeks to involve patients in co-production of their health service delivery, the health services´ aims and context could restrict this co-production.

• Melbye, Marita Christina Susanne & Kirchhoff, Ralf (2020). Tverrprofesjonell in situ simulering på intensivavdelingen - erfaringer blant leger og sykepleiere. Inspira – tidsskrift for anestesi-, operasjon- og intensivsykepleiere. ISSN 0809-9707. s. 13–21. Fulltekst i vitenarkiv Vis sammendrag

  Bakgrunn: Det å handle korrekt og effektivt i krevende og uventede situasjoner, er ofte avgjørende for faglig forsvarlig pasientbehandling i intensivavdelinger. In situ simulering kan være en god pedagogisk metode for trening av situasjoner som krever høyt nivå av teamfungering. For at slik simulering skal gi et godt læringsutbytte må den være godt planlagt og organisert. Egenskaper ved læringsmiljøet vil være forhold som kan påvirke individuell og kollektiv læring på kort eller lang sikt. Hensikt: Hensikten med denne studien var å utforske hvilke erfaringer leger og sykepleiere har med tverrprofesjonell in situ simulering ved intensivavdelinger. Hovedfokuset var å utforske organisering av in situ simulering og egenskaper ved læringsmiljøet. Metode: Studien har et kvalitativt design. Data er samlet inn via tre fokusgruppeintervju med totalt tre leger og elleve sykepleiere. Datamaterialet er analysert inspirert av Malteruds modifiserte versjon av systematisk tekstkondensering. Resultat: To meningsbærende enheter ble identifisert. Den første meningsbærende enheten «Organisering av tverrprofesjonell in situ simulering ved intensivavdelinger» består av underkategoriene «In situ simulering er ulikt organisert for leger og sykepleiere» og «Egen og andres roller i teamtreningen». Den andre meningsbærende enheten «Egenskaper ved læringsmiljøet av betydning for læring ved tverrprofesjonell in situ simulering» består av underkategoriene «Sårbarhet i simuleringssituasjonen» og «Fasilitator og læringsmiljøet». Konklusjon: Studien viser at deltakerne har ulike erfaringer med tverrprofesjonell simulering ved intensivavdelinger i forhold til organiseringen og læringsmiljøet. Studien kan bidra til at leger og sykepleiere på intensivavdelinger blir mer bevisst på betydningen av å trene på teamarbeid sammen gjennom in situ simulering. Den kan skape økt forståelse for at både deltakere og fasilitator er av betydning for å skape et godt læringsmiljø under simulering. Studien kan være aktuell for ledere som har ansvar for kvalitetsforbedringsarbeid og pasientsikkerhet. Funnene kan ha overførbarhet til andre typer avdelinger som benytter in situ simulering som pedagogisk verktøy.

• Frisvoll, Inger Cecilie; Aarseth, Turid & Kirchhoff, Ralf (2020). Å skrive ut pasienter til kommunene - faglig rasjonalitet under press? Tidsskrift for omsorgsforskning. ISSN 2387-5976. 6(3), s. 1–15. doi: 10.18261/issn.2387-5984-2020-03-04. Fulltekst i vitenarkiv Vis sammendrag

  Artikkelen tar opp hvordan beslutninger om når en pasient kan utskrives fra sykehus for å få oppfølging i hjemkommunen, fattes. Bakgrunnen er samhandlingsreformens forventning om økt behandlingsansvar for kommunene, økt formalisering av hvordan utskrivning skal skje og observert nedgang i liggetid. Hovedtyngden av forskningslitteraturen omhandler hvordan samhandlingsreformen har påvirket kommunehelsetjenesten. Vi ser på hva som skjer på sykehusene, før pasientene meldes utskrivningsklare til kommunene. Med grunnlag i kvalitative intervju og en kvantitativ spørreundersøkelse ses kjennetegn ved legenes utskrivningsbeslutninger i lys av regel- og konsekvensorienterte beslutningsmodeller. Samlet bekrefter svarene fra legene, både i den kvalitative og kvantitative undersøkelsen, deres muligheter til å fatte individuelle og faglig baserte utskrivningsbeslutninger. Forsterkningen av formelle rammer for utskrivningsbeslutninger synes å ha liten betydning. Prosedyrekravene forvaltes av sykepleierne; legene synes ikke å oppfatte at reguleringene begrenser suvereniteten til de rent faglige vurderingene. Samtidig tyder våre funn på at individuelle faglige vurderinger er under press og at forhold internt i sykehuset kan ha betydning for hvilke utskrivningsbeslutninger som fattes. Flertallet mener pasientene skrives ut på riktig tidspunkt, men mange kjenner seg igjen i situasjoner der pasienter har blitt skrevet ut for tidlig. Nøkkelord: Samhandlingsreform, utskrivninger, sykehusleger, kommunehelsetjeneste, rasjonelle beslutningsmodeller, mixed methods

• Kirchhoff, Ralf; Vik, Erlend & Aarseth, Turid (2019). Management and reforms in the Nordic hospital landscape. Journal of Health Organisation and Management. ISSN 1477-7266. 33(5), s. 588–604. doi: 10.1108/JHOM-07-2018-0183. Fulltekst i vitenarkiv Vis sammendrag

  Purpose: The purpose of this paper is to give a comprehensive and updated analysis of the available academic literature (2000–2016) on management and reforms in the Nordic hospital landscape. Design/methodology/approach: A systematic literature review was conducted by searching articles in Scopus database, as well as applicable journals. Findings: The vast majority of the Nordic articles are relatively coherent on the following: first, the reforms have created a change in the manager role or rather there are new expectations about the content of the manager role. Second, the reforms entail tension between profession and administration. Doctors who are managers identify themselves primarily as doctors, implicating that the medical logic has not competed out by an administrative logic. Third, the reforms have brought new opportunities for nurses. Still, nurse managers perceive tension between the profession and administration. Fourth, new public management (NPM) is often the framework or background for understanding change in hospitals or manager roles in the articles. Fifth, the majority of the articles are focusing on management as a general key concept. Research limitations/implications: The search was limited to the period 2000–2016 and have only included articles published in English. There are several limitations around these choices: first, research published in a language other than English (i.e. Norwegian, Swedish, Finnish or Danish) are excluded. Second, it may take years before consequences of hospital reforms have impact on management and manager roles. Some of the articles are published relatively shortly after the implementation of the reform. Third, many factors in a reform have impact on management or manager roles, thus it is challenging to give simple explanations. Practical implications: The authors would welcome a more pluralistic approach, and contributions that are not quite so busy describing and criticizing the NPMization of hospitals and management. In particular, the authors look forward to more research on how other reform trends, such as NPG, affect management in hospitals. Originality/value: This review summarizes the literature on how academic literature (2000–2016) – in a Nordic reform context – has dealt with management in hospitals. The study reflects upon the academic literature per se. There are tendencies to explore reforms and management with some conceptual equivalence. Keywords: public sector, hospital managers, hospital management, roles, hospital reform

• Oksavik, Jannike Dyb & Kirchhoff, Ralf (2019). Moralsk stress blant sykepleiere i medisinske og kirurgiske avdelinger. Nordisk sygeplejeforskning. ISSN 1892-2678. 9(2), s. 118–127. doi: 10.18261/issn.1892-2686-2019-02-05. Fulltekst i vitenarkiv Vis sammendrag

  Fremtidsprognoser tilsier at det blir mangel på helsepersonell i Norge og i den vestlige verden. Det å ta vare og holde på kvalifisert helsepersonell er dermed viktig. I studien rettes søkelyset mot moralsk stress, og faktorer som kan ha sammenheng med opplevelsen av moralsk stress hos sykepleiere i sykehusavdelinger. Resultatene baserer seg på en tverrsnittstudie besvart av 247 sykepleiere våren 2017. Vi anvendte måleinstrumentet Moralsk stress termometeret. Dataanalysen ble gjort ved korrelasjon, t-test og multippel regresjon. Resultatene indikerer at moralsk stress var utbredt blant sykepleiere. Sykepleiere opplevde mer moralsk stress i medisinske enn i kirurgiske avdelinger. Kontekstuelle faktorer som avdelingstilhørighet og opplevelse av utilstrekkelig bemanning, hadde mer betydning for moralsk stress enn individuelle faktorer som alder, utdanningsnivå og antall år i jobben. Siden kontekstuelle faktorer hadde mest betydning, anbefaler vi at ledelsen i sykehusavdelinger setter inn tiltak for å redusere moralsk stress.

• Huby, Guro Øyen; Cook, Ailsa & Kirchhoff, Ralf (2018). Can we mandate partnership working? Top down meets bottom up in structural reforms in Scotland and Norway. International Journal of Integrated Care (IJIC). 26(2), s. 109–119. doi: 10.1108/JICA-11-2017-0041. Fulltekst i vitenarkiv Vis sammendrag

  Purpose Partnership working across health and social care is considered key to manage rising service demand whilst ensuring flexible and high-quality services. Evidence suggests that partnership working is a local concern and that wider structural context is important to sustain and direct local collaboration. “Top down” needs to create space for “bottom up” management of local contingency. Scotland and Norway have recently introduced “top down” structural reforms for mandatory partnerships. The purpose of this paper is to describe and compare these policies to consider the extent to which top-down approaches can facilitate effective partnerships that deliver on key goals. Design/methodology/approach The authors compare Scottish (2015) and Norwegian (2012) reforms against the evidence of partnership working. The authors foreground the extent to which organisation, finance and performance management create room for partnerships to work collaboratively and in new ways. Findings The two reforms are held in place by different health and social care organisation and governance arrangements. Room for manoeuvre at local levels has been jeopardised in both countries, but in different ways, mirroring existing structural challenges to partnership working. Known impact of the reforms hitherto suggests that the potential of partnerships to facilitate user-centred care may be compromised by an agenda of reducing pressure on hospital resources. Originality/value Large-scale reforms risk losing sight of user outcomes. Making room for collaboration between user and services in delivering desired outcomes at individual and local levels is an incremental way to join bottom up to top down in partnership policy, retaining the necessary flexibility and involving key constituencies along the way.

• Bøyum-Folkeseth, Linda & Kirchhoff, Ralf (2018). Endringer i klageregler : stor økning i klager etter samhandlingsreformen? I Hogset, Heidi; Berge, Dag Magne & Dale, Karl Yngvar (Red.), Det regionale i det internasjonale : fjordantologien 2018. Universitetsforlaget. ISSN 9788215031217. s. 155–166. doi: 10.18261/9788215031224-2018-09. Fulltekst i vitenarkiv Vis sammendrag

  Vi diskuterer rettssikkerhetsmessige aspekter ved endringene i klageregler for pasienter i primærhelsetjenestene. Endringene synes ikke å ha ført til økt rettssikkerhet for pasienter.

• Kirchhoff, Ralf; Bøyum-Folkeseth, Linda; Gjerde, Ingunn & Aarseth, Turid (2016). Samhandlingsreformen og fastlegene – et avstandsforhold? Tidsskrift for omsorgsforskning. ISSN 2387-5976. 2(2), s. 95–106. doi: 10.18261/ISSN.2387-5984-2016-02-04. Fulltekst i vitenarkiv Vis sammendrag

  Samhandlingsreformen stiller forventninger til at fastlegene i større grad skal integreres både horisontalt og vertikalt i helsetjenesten. Med utgangspunkt i tre ulike perspektiver analyserer artikkelen hvorvidt disse forventninger er innfridd. Policyperspektivet, som tar utgangspunkt i analyser av policydokument og fastlegeforskriften, viser at reformen i liten grad har utfordret fastlegens selvstendige rolle i kommunen. Det nye avtalesystemet rommer heller ikke strukturer og mekanismer som sikrer vertikal og horisontal integrasjon. Kommuneperspektivet, som understøttes av intervjudata fra kommunale ledere på ulike nivåer, viser at det er krevende for den enkelte kommune å styre fastlegene via avtaleverket og forskrift om fastlegeordning i kommunene. Respondenter i vårt materiale viser mye velvilje og interesse for å utvikle samarbeidet med legetjenesten i tråd med samhandlingsreformens ambisjoner. Samtidig uttrykkes skuffelse over fastlegenes manglende involvering, og det synes langt på vei å være akseptert at fastlegene står «utenfor» den kommunale helse- og omsorgstjenesten. Fastlegeperspektivet, der vi har analysert svar fra fastleger i forbindelse med tilsyn, bekrefter bildet av fastlegene som noe distanserte i forhold til reformen og dens virkemidler.

• Kirchhoff, Ralf & Berg, Helen (2016). Bruk av videokommunikasjonsteknologi i hverdags- og/eller telerehabilitering. Sykepleien Forskning. ISSN 1890-2936. 11(2), s. 174–183. doi: 10.4220/Sykepleienf.2016.57820. Fulltekst i vitenarkiv
• Kirchhoff, Ralf & Ljunggren, Birgitte (2016). Aspects of Equality in Mandatory Partnerships - From the Perspective of Municipal Care in Norway. International Journal of Integrated Care (IJIC). 16(2), s. 1–8. doi: 10.5334/ijic.2025. Fulltekst i vitenarkiv Vis sammendrag

  Introduction: This paper raises questions about equality in partnerships, since imbalance in partnerships may effect collaboration outcomes in integrated care. We address aspects of equality in mandatory, public-public partnerships, from the perspective of municipal care. We have developed a questionnaire wherein the Norwegian Coordination Reform is an illustrative example. The following research question is addressed: What equality dimensions are important for municipals related to mandatory partnerships with hospitals? Theory/methods: Since we did not find any instrument to measure equality in partnerships, an explorative design was chosen. The development of the instrument was based on the theory on partnership and knowledge about the field and context. A national online survey was emitted to all 429 Norwegian municipalities in 2013. The response rate was in total 58 percent (n = 248). The data were mainly analysed using Principal component analysis. Results: It seems that the two dimensions “learning and expertise equality” and “contractual equality” collects reliable and valid data to measure aspects of equality in partnerships. Discussion: Partnerships are usually based on voluntarism. The results indicate that mandatory partnerships, within a public health care system, can be appropriate to equalize partnerships between health care providers at different care levels.

• Rutle, Adrian; Simonsen, Kent Inge Fagerland; Schaathun, Hans Georg & Kirchhoff, Ralf (2015). Model-driven software engineering in practice: A content analysis software for health reform agreements. Procedia Computer Science. 63, s. 545–552. doi: 10.1016/j.procs.2015.08.383. Fulltekst i vitenarkiv Vis sammendrag

  The Coordination Reform of 2012 requires Norwegian municipalities and regional health authorities to enter into legally binding service agreements. Although several research projects have been undertaken to analyse the implications of this reform, there is no central database where researches can be given access and analyse the service agreements. In this paper we present how we use model-driven software engineering and user-centric design in an initial development of an information system designed to allow researches to access and analyse service agreements. For this project, it was crucial to discuss the requirements of the system with domain-experts at a high level of abstraction in order to elicit feedback so that the development could proceed at a fast pace and in the right direction. Furthermore, given time and resource constraints, we elected to use a model driven approach using automatic code generation coupled with high-productivity frameworks. In this way we were able to create prototypes so that the developers could get fast feedback from the domain-experts and improvements could be implemented with minimal effort.

• Brekk, Åge & Kirchhoff, Ralf (2015). Hvor ble det av pasienten i samarbeidsavtalene? Nordiske organisasjonsstudier. ISSN 1501-8237. 17(3), s. 37–62. Fulltekst i vitenarkiv Vis sammendrag

  Nøkkelord: samhandlingsreformen, brukermedvirkning, iverksetting, samarbeidsavtaler. Keywords: The Coordination Reform, user participation, implementation, service agreements.

• Grimsmo, Anders; Kirchhoff, Ralf & Aarseth, Turid (2015). Samhandlingsreformen i Norge. Nordiske organisasjonsstudier. ISSN 1501-8237. 17(3), s. 3–12. Fulltekst i vitenarkiv Vis sammendrag

  Samhandlingsreformen ble innført i Norge 1.1.2012 og kan beskrives som en koordinerings- og retningsreform, hvor økonomiske, juridiske, orga-nisatoriske og faglige virkemidler skal fremme det overordnete målet om helhetlige og smidige pasientforløp (St.meld. nr. 47 (2008–2009); St.meld. nr. 16 (2010–2011)). Spesialist- og primærhelsetjenesten skal i større grad samhandle med hverandre, og kommunene har fått en større del av ansvaret for helsetjenestene. Reformen har slektskap med helsereformer i våre nabo-land (OECD 2013a, 2013b). Det svenske lokalvård-konseptet og den danske modellen for kommunal medfinansiering av sykehustjenester1 er begge vik-tige inspirasjonskilder for utvikling av helsetilbud utenfor sykehus. Refor-men har videre klare likhetstrekk med partnerskapstenkningen i Health Action Zones-reformen i England, og med pågående reformer i Australia og Skottland (Davies mfl. 2009; Freeman 2008).Kort tid etter at samhandlingsreformen ble iverksatt i 2012, fikk Nor-ges forskningsråd i oppdrag å etablere en løpende evaluering. I alt er seks prosjekter blitt etablert. I dette spesialnummeret presenteres noen resulta-ter fra prosjektet «Samhandling og pasientforløp i støpeskjeen» (SPIS). Som en bakgrunn for de organisasjonsfaglige spørsmål som ligger til grunn for SPIS-prosjektet og de seks artiklene som inngår i spesialnummeret, skal vi først gi en kortfattet fremstilling av noen særtrekk ved norsk helsetjeneste samt reformens begrunnelser og virkemidler.

• Kirchhoff, Ralf; Grimsmo, Anders & Brekk, Åge (2015). Kommuner og helseforetak - ble de enige om noe? Tidsskrift for velferdsforskning. ISSN 0809-2052. 18(2), s. 125–141. Fulltekst i vitenarkiv
• Kirchhoff, Ralf & Nesset, Erik (2014). Tyske og norske sykehusleger i Norge - ulike syn på faglig oppdatering? I Amdam, Jørgen; Helgesen, Øyvind & Sæther, Knut-Willy (Red.), Det mangfaldige kvalitetsomgrepet. Fjordantologien 2013. Forlag1. ISSN 9788282850780. s. 195–220. Fulltekst i vitenarkiv
• Kirchhoff, Ralf (2011). Tilhørighet til arbeidsplassen: en komparativ studie av tyske og norske sykehusleger i Norge. Tidsskrift for samfunnsforskning (TfS). ISSN 0040-716X. 52(2), s. 181–210. Fulltekst i vitenarkiv Vis sammendrag

  ORGANIZATIONAL COMMITMENT. A COMPARATIVE STUDY OF GERMAN AND NORWEGIAN HOSPITAL PHYSICIANS IN NORWAY The article analyses whether German physicians in Norway are any less organizationally committed to Norwegian hospitals than Norwegian physicians are. The article is based on national survey data collected in spring 2009 (N=627) among Norwegian and German hospital physicians in Norway. We used questions from a validated survey instrument to illustrate that German and Norwegian physicians, despite comprehensive hospital reforms in Norway, are relatively highly organizationally committed to their workplace. Generally, German hospital physicians show slightly more organizational commitment then Norwegian hospital physicians. Our study demonstrates that the same independent variables explaining organizational commitment in a Norwegian physician sample do not necessarily have the same effect on organizational commitment in a German physician sample. Differences between our national samples can to some extent be explained by focusing on German physicians’ prior working conditions in Germany and traditions for clinical leadership within German public hospital organizations.

• Kirchhoff, Ralf (2010). Forskjeller i opplevelse av arbeidsmiljøet blant norske og tyske overleger i Norge :. Søkelys på arbeidslivet. ISSN 1504-8004. 27(1/2), s. 87–104. Fulltekst i vitenarkiv Vis sammendrag

  Behov for høyt kvalifisert helsepersonell i Norge, og et smidigere regelverk for godkjenning av legenes utdanning og praksis innenfor EØS-området, har lagt grunnlaget for en økende arbeidsmigrasjon av utenlandske leger til Norge. En gjennomgående problemstilling i artikkelen er hvorvidt og på hvilke områder legenes bakgrunn har betydning for deres vektlegging av ulike aspekt ved psykososialt arbeidsmiljø. Hovedfunnene fra en survey våren 2009 viser at nasjonal bakgrunn har betydning i forhold til overleger sin opplevelse av tidspress og administrativt arbeid. Tyske overleger opplever i mindre grad tidspress som et problem enn norske overleger. Samtidig opplever tyske overleger større problemer med administrativt arbeid enn norske overleger

Se alle arbeider i NVA

• Kirchhoff, Ralf; Vik, Erlend & Ødegård, Atle (2024). Helseledelse : om utfordringer og lederroller i endring. Fagbokforlaget. ISBN 9788245037081. 253 s. Fulltekst i vitenarkiv

Se alle arbeider i NVA

• Lyngdal, Anne Bang; Kirchhoff, Ralf; Skoog, Therése Julia Iréne; Norheim, Aud Lise & Arntzen, Sivert (2026). Akkrediteringsrapport - Oslo Nye Høyskole - Søknad om akkreditering som høyskole. doi: https:/www.nokut.no/globalassets/nokut/rapporter/akkreditering-institusjon/2026/onh_soknad-om-akkreditering-som-hoyskole_2026.pdf. Fulltekst i vitenarkiv
• Kirchhoff, Ralf (2026). Fra gjennomtrekk til gjennomslag: Ledelse som gir varig bemanning i kommunal helse og omsorg. doi: https:/www.arendalsuka.no/program/fra-gjennomtrekk-til-gjennomslag-ledelse-som-gir-varig-bemanning-i-kommunal-helse-og-omsorg. Fulltekst i vitenarkiv Vis sammendrag

  Hvordan kan kommunale helse- og omsorgstjenester ta i bruk ledelses- og organisasjonsmodeller som faktisk gir varig bemanning i en sektor med økende kompleksitet og store rekrutteringsutfordringer? Demografiske endringer og nye kompetansebehov gjør det nødvendig å styrke kunnskapen om hva som faktisk virker i praksis og hvilke modeller som fungerer i ulike tjenestekontekster. Det bukes mange modeller og tiltak i ulike kommuner, men vi vet fortsatt for lite om hva som faktisk gir varig effekt i praksis. Det planlagte Universitetssykehjemmet i Agder (2030) skal bli en arena for å prøve ut, teste og videreutvikle eksisterende modeller i reelle tjenestemiljøer. Målet er å skape et solid kunnskapsgrunnlag for mer bærekraftige løsninger nasjonalt. I dette arrangementet samles representanter fra tjenestene, forvaltning, forskning og politikk for å diskutere hvordan vi kan gå fra gjennomtrekk til gjennomslag – og hvilke strukturer og ledelsesgrep som kan bidra til stabile fagmiljøer, bedre arbeidsmiljø og mer attraktive arbeidsplasser.

• Kirchhoff, Ralf; Blindheim, Kari & Midtbust, May Helen (2026). Har TikTok blitt vår nye «helsesøster»? doi: https:/www.arendalsuka.no/program/har-tiktok-blitt-var-nye. Fulltekst i vitenarkiv
• Kirchhoff, Ralf (2026). Medierepresentasjoner av kunstig intelligens i høyere utdanning: kulturelle dragkamper i Khrono (2022–2026). Fulltekst i vitenarkiv
• Besnier, Elodie Anne Suzanne; Bungudo, Binyam Bogale; Solberg, Mads; Kirchhoff, Ralf; Oksavik, Jannike Dyb & Marchant-Salgado, Monica Cecilia [Vis alle 7 forfattere av denne artikkelen] (2026). Experiences and Implementation of Patient-initiated follow-up implementation for chronic conditions: A qualitative evidence synthesis protocol. doi: 10.5281/zenodo.19450475. Fulltekst i vitenarkiv Vis sammendrag

  Background The burden of chronic conditions has been growing worldwide. These conditions put an enormous pressure on health systems, communities and patients due to the daily management and close follow-up they require. Additionally, the COVID-19 pandemic severely disrupted routine care for people with chronic conditions, creating and expanding a need to explore new digital or hybrid care models with very little time and preparation. Patient-initiated follow up (PIFU) is an increasingly popular model for providing healthcare, especially for patients whose condition require follow-up over a prolonged period. PIFU holds the promise of more efficient health services and patient empowerment, including in the context of health emergencies. While this complex intervention has grown in popularity for chronic disease management, there is considerable variation in its implementation across health conditions, care settings, and patient groups. These differences and their implications for the design and delivery of PIFU approaches are poorly understood. Existing literature found mixed results in the experience of patients under PIFU approaches while the views and experiences of health professionals and other stakeholders have been comparatively less explored. As PIFU approaches are being adopted more widely, it is essential to better understand how stakeholders view, experience and deliver these approaches in order to better understand the factors affecting PIFU’s implementation, including as an approach for sustaining routine care during health emergencies. This qualitative evidence synthesis links to a systematic review assessing the effects of patient-initiated follow-up for diabetes care (PROSPERO registration number 1331488) (Bogale et al., 2026). Objectives (1) To inform the design, delivery and use of future PIFU approaches for chronic conditions by exploring the views, experiences and practices of patients enrolled in PIFU, their relatives, and healthcare workers, managers and other professionals involved in providing PIFU services for people with chronic conditions. (2) To explore differences between PIFU under normal circumstances and PIFU in times of health emergencies. Search methods  We will search the electronic databases MEDLINE, CINAHL Complete, EMBASE, Web of Science, AJOL and ProQuest Dissertations and Theses for studies published since 1995. We will conduct a grey literature search in Google. We will conduct a cited reference search for all included studies in Paperfetcher.  Selection criteria  We will include primary qualitative studies on stakeholders’ views, experiences and practices regarding PIFU approaches for chronic conditions (apart from cancer). Stakeholders include adult patients living with one or more chronic conditions managed through a PIFU approach, their relatives, healthcare workers and managers involved in PIFU services, and other support staff involved in these services. We will include studies from any country and in any settings where PIFU is received or delivered. We will not exclude studies on the basis of language. Data collection and analysis We will use a framework analysis approach for data extraction and synthesis using NVivo15. We will assess methodological limitations using CASP, unless the beta version of CAMELOT in iSoQ becomes available before our extraction begins. We will use the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach in iSoQ to assess our confidence in each finding. We will examine each review finding to identify factors that may influence intervention implementation and developed implications for practice and for emergency preparedness.

• Kirchhoff, Ralf; Vik, Erlend & Ødegård, Atle (2024). Helseledelse : om utfordringer og lederroller i endring. I Kirchhoff, Ralf; Vik, Erlend & Ødegård, Atle (Red.), Helseledelse : om utfordringer og lederroller i endring. Fagbokforlaget. ISSN 9788245037081. s. 13–22. Fulltekst i vitenarkiv
• Ryan, R.; Wolfenden, Luke; Shepperd, Sasha; Cumpston, M.; Parkhill, A. & Merner, B [Vis alle 11 forfattere av denne artikkelen] (2023). Why we need a new Cochrane Thematic Group on Person-centred care, Health Systems and Public Health. Fulltekst i vitenarkiv Vis sammendrag

  Background: Person-centred health and public health systems are systems in which healthcare providers, managers, and planners involve consumers/service users as partners in planning, delivering, and evaluating services. Such approaches are key to ensuring that health and public health systems interventions meet the needs of consumers and other stakeholders, and promote engagement, empowerment, and equity. Person-centred approaches are also necessary for safe, high-performing, sustainable and resilient health, and public health systems and are key to achieving the health-related Sustainable Development Goals. In recognition of this, Cochrane has agreed to establish a Thematic Group in this area. Goal of the Thematic Group: To collaborate in providing leadership and expertise to support Cochrane’s production of priority syntheses on person-centred health and public health systems, and working to ensure more effective, equitable, and accessible systems for all. Key contributions of the Thematic Group: The Thematic Group brings together the expertise of Cochrane Effective Practice and Organisation of Care (EPOC), Cochrane Consumers and Communication (CCC), and Cochrane Public Health (CPH) to: • Provide strategic leadership on review priorities within the Thematic Group scope, working with diverse stakeholders. • Advance methods to support evidence synthesis in complex areas that meet the needs of stakeholders. This may include the use of logic models to articulate intervention pathways and shape syntheses, syntheses of qualitative evidence, and approaches for coproducing syntheses with stakeholders. • Contribute to knowledge translation and evidence-informed decision making for personcentred care, health, and public health systems, drawing on implementation science and other relevant disciplines. • Share and strengthen capacity with partners in the Global South. Conclusions: By integrating evidence on person-centred health systems and public health, this new Thematic Group will contribute to understanding the interconnectedness between health systems, public health, and personal, social, and environmental contexts to promote healthy lives and well-being for all people. Relevance and importance to consumers: Patients, carers, and families are central to the concept of person-centred health and public health systems. This Thematic Group will contribute to advancing this perspective, identifying review priorities from the perspectives of consumers and building an evidence base for decision-making.Transformation of Cochrane systems and processes for evidence synthesis

• Bjåen, Bjørgulf K. (avisa Vårt Land) & Kirchhoff, Ralf (2021). Pandemien river i Norge - men ingen flere intensivplasser. [Journal]. https://www.vl.no/nyheter/2021/12/17/pandemien-river-i-norge. Fulltekst i vitenarkiv
• Kjølås, Bibbi & Kirchhoff, Ralf (2021). Intervju om helseledere i Møre og Romsdal. [Radio]. NRK Møre og Romsdal. Fulltekst i vitenarkiv
• Kirchhoff, Ralf (2020). Koronakrisen – om å gjøre det rette, også når det er tvil. Fulltekst i vitenarkiv
• Kirchhoff, Ralf & Solberg, Mads (2020). A framework for policy research on governmental trust and AAL-technology: a proposal. Fulltekst i vitenarkiv
• Solberg, Mads & Kirchhoff, Ralf (2019). Robotteknologi og helse – en retrospektiv innholdsanalyse av norske avisartikler fra 2000 til 2018. Fulltekst i vitenarkiv
• Oksavik, Jannike Dyb; Kirchhoff, Ralf; Solbjør, Marit & Sogstad, Maren Kristine Raknes (2018). Multimorbidity and patient involvement. Fulltekst i vitenarkiv
• Kirchhoff, Ralf; Kongshaug, Arnhild Vestnes & Vadset, Tove Bjørnland (2017). Self-Assessment of Intensive Care Nurses’ Team Performance Compared with Intensive Care Nursing Students. Prehospital and Disaster Medicine. ISSN 1049-023X. 32. doi: 10.1017/S1049023X17005817. Fulltekst i vitenarkiv
• Bøyum-Folkeseth, Linda & Kirchhoff, Ralf (2017). Endringer i klageregler – stor økning i klager etter samhandlingsreformen? Fulltekst i vitenarkiv
• Kirchhoff, Ralf; Aarseth, Turid & Vik, Erlend (2017). Management and reforms in the Nordic hospital landscape - A literature review. Fulltekst i vitenarkiv
• Haugan, Idun & Kirchhoff, Ralf (2016). Kommunene er uforberedt på velferdsteknologi. [Journal]. gemini.no. Fulltekst i vitenarkiv
• Huby, Guro Øyen & Kirchhoff, Ralf (2016). Bestemor med brukket rygg i helsetjenestenes hinderløype. Fulltekst i vitenarkiv
• Ljunggren, Elin Birgitte & Kirchhoff, Ralf (2015). Equality in partnerships: The Coordination Reform in Norway. Fulltekst i vitenarkiv
• Kirchhoff, Ralf & Berg, Helen (2015). Scoping review: Hverdagsrehabilitering og videokommunikasjon. Fulltekst i vitenarkiv
• Kirchhoff, Ralf & Berg, Helen (2015). Videokommunikasjon i hverdagsrehabilitering. Fulltekst i vitenarkiv
• Kirchhoff, Ralf (2015). Samhandling i støpeskjeen - kunnskap og forskning om samhandlingsreformen. Fulltekst i vitenarkiv
• Kirchhoff, Ralf & Ljunggren, Elin Birgitte (2015). Equality in partnerships. The Coordination Reform in Norway. International Journal of Integrated Care (IJIC). 15(5). Fulltekst i vitenarkiv
• Kirchhoff, Ralf & Ljunggren, Elin Birgitte (2014). Kunnskapsglidning: Likeverdig kunnskap i helseforetak og kommuner. Fulltekst i vitenarkiv
• Kirchhoff, Ralf & Ljunggren, Elin Birgitte (2014). Towards inter-organizational equality? The Coordination Reform in Norway. Fulltekst i vitenarkiv
• Brekk, Åge & Kirchhoff, Ralf (2014). Hvor ble det av pasientene i samarbeidsavtalene? Fulltekst i vitenarkiv
• Kirchhoff, Ralf (2013). Foreløpige analyseresultat basert på avtaletekstene fra tre tjenesteavtaleområder. Fulltekst i vitenarkiv
• Kirchhoff, Ralf & Grimsmo, Anders (2013). Samhandling og pasientforløp i støpeskjeen - forløpige resultat fra arbeidspakke 1 (avtalene). Fulltekst i vitenarkiv
• Kirchhoff, Ralf (2013). Samarbeidsavtaler til statistikkformål. Fulltekst i vitenarkiv
• Kirchhoff, Ralf (2013). Tyskland og Norge - to syn på kvalitet i helsesektoren? Fulltekst i vitenarkiv
• Kirchhoff, Ralf (2010). Management contexts and their relevance on physicians organizational commitment. A comparative study of German and Norwegian hospital physicians in Norway. Fulltekst i vitenarkiv
• Kirchhoff, Ralf (2009). Utenlandske forskere i Norge: ulike erfaringer og noen fellestrekk. Fulltekst i vitenarkiv Vis sammendrag

  Foredraget tok utgangspunkt i aktuell forskning rundt temaet mobilitet og mottak av utenlandske forskere i Norge. Egen forskning rundt mottak av utenlandske leger (tyske) i Norge og disse legenes erfaringer ble formidlet.

• Kirchhoff, Ralf (2008). German physicians' perceived working experiences in Sweden and Norway. Fulltekst i vitenarkiv Vis sammendrag

  The purpose of this paper is to examine whether German physicians' perceived working experiences in Norway or Sweden differ from those countries.

• Kirchhoff, Ralf (2008). Hva er forskning? s. 1–1. Fulltekst i vitenarkiv
• Kirchhoff, Ralf (2007). Tyske og norske leger - når kultur teller/ikke teller. Fulltekst i vitenarkiv Vis sammendrag

  Phd-prosjektet reiser spørsmål om kulturbakgrunn, sett i forhold til norsk nasjonal kultur, har betydning for profesjonsutøvelse i en sykehuskontekst. Jeg tar utgangspunkt i tyske leger som har arbeidsmigrert til Norge i perioden 2002 ¿2006. Teori-/hypotesetilnærmingene i prosjektet sees i hovedsak i lys av Geert Hofstedes begrepsapparat (Hofstede, 1991). Her skal jeg gjøre rede for hvordan jeg metodisk har tenkt å utforske hvordan og under hvilke betingelser kulturforskjeller teller/ikke teller i en norsk sykehuskontekst. I den forbindelse har jeg avledet enkelte hypoteser, og som jeg håper forskningsprosjektet skal gi noen svar på.

• Kirchhoff, Ralf (2007). Konfirmasjon ? Styrer pengene ungdommenes verdivalg? Fri tanke. ISSN 1500-3388. s. 1–1. Fulltekst i vitenarkiv Vis sammendrag

  Konfirmasjon er et høydepunkt i mange unge voksnes liv. At noen ungdommer favoriserer enkelte konfirmasjonsvarianter på grunnlag av økonomiske motiv har hittil ikke vært fremme i den offentlige debatt. Hvor mange ungdommer som velger sitt konfirmasjonsalternativ på grunn av økonomiske overveielser, vet forskningen lite om. Det er imidlertid en kjent sak i mange ungdomsmiljøer at de tror de får best økonomisk utbytte ved å velge det som foreldre/slekta forventer av dem. I Norge vil det i en rekke byer og steder bety kristelig konfirmasjon. Det at ungdommene tror det er slik, behøver ikke å bety at det er slik. Konfirmasjonspengeundersøkelsen fra Ålesund gir noen svar.

• Kirchhoff, Ralf (2006). Konfirmasjon ? Styrer pengene ungdommenes verdivalg? Fulltekst i vitenarkiv Vis sammendrag

  Konfirmasjon er et høydepunkt i mange unge voksnes liv. At noen ungdommer favoriserer enkelte konfirmasjonsvarianter på grunnlag av økonomiske motiv har hittil ikke vært fremme i den offentlige debatt.

• Kirchhoff, Ralf (2005). EU-kontor med fokus på vestnorske interesser. s. 1–1. Fulltekst i vitenarkiv Vis sammendrag

  Kommuner som ikke er medlemmer i Vest-Norges Brusselkontor og medlemskommuner mener at det er mer hensiktsmessig at kommunen bruker brusselkontoret enn å bygge opp egen kompetanse på området.

• Liepelt, Silje; Kirchhoff, Ralf; Sundal, Hildegunn & Dale, Karl Yngvar (2025). Healthcare Professionals’ Experience with Root Cause Analysis: A Case Study. Norges teknisk-naturvitenskapelige universitet. ISSN 9788232694297. Fulltekst i vitenarkiv Vis sammendrag

  Introduction: Over the past three decades, the emphasis in healthcare has gradually shifted from individual responsibility for safety, quality, and performance to a systems-based perspective for addressing variation and adverse events. Despite extensive efforts to improve patient safety, adverse events remain a persistent challenge, with the World Health Organization (WHO) estimating that approximately 10% of patients worldwide experience harm during hospitalization. Root cause analysis is widely used in healthcare as a structured method for investigating sentinel events—unexpected incidents resulting in severe harm or death. The method aims to identify systemic weaknesses in processes, communication, and organizational structures to facilitate targeted safety interventions. However, its effectiveness in driving long-term improvements has been debated, as many RCA efforts remain reactive rather than proactively strengthening healthcare systems. Aim: To explore RCA and how healthcare professionals in a Norwegian hospital setting experience RCA following a sentinel event. The thesis sheds light on practical applications of RCA, considerin challenges and the potential for fostering improvements in patient safety. Methods: A qualitative single-case design was employed to explore healthcare professionals’ experience with RCA in a specialized hospital setting. Data collected involved semistructured interviews with RCA team members and managers and document analysis of RCA reports, policies, and Norwegian guidelines. Data were analyzed using thematic analysis to identify key themes related to the RCA process. Findings: Three articles present the findings, illustrating the complexities of implementing RCA in specialized healthcare. The dissertation highlights RCA’s potential to facilitate learning and improvement but also finds that resource constraints, inconsistent practices, and variations in implementation often hinder its effectiveness. Conclusion: This study highlights the potential and limitations of RCA as a tool for improving patient safety. While RCA provides a structured approach to learning from adverse events, its impact is contingent on organizational commitment, the availability of resources, and the ability to integrate findings into broader safety initiatives. This thesis contributes to an understanding of how healthcare organizations can strengthen their adaptive capacity by critically examining RCA’s role within a resilience-based framework. The findings emphasize the need for more proactive and integrative approaches to patient safety, ensuring that RCA identifies systemic weaknesses and drives meaningful and sustainable improvements in healthcare quality and safety.

• Pukstad, Brita; Oestvang, Janne; Ingebrigtsen, Erik; Lenschow, Harald; Onsøyen, Lars E. & Kirchhoff, Ralf [Vis alle 7 forfattere av denne artikkelen] (2020). Ph.d.-administrative støttesystemer. Norges teknisk-naturvitenskapelige universitet. Fulltekst i vitenarkiv
• Vadset, Tove B.; Kongshaug, Arnhild Vestnes & Kirchhoff, Ralf (2016). Best mulig forberedt - evaluering av simulatorbasert samtrening i intensiv sykepleie. Norges teknisk-naturvitenskapelige universitet. Fulltekst i vitenarkiv Vis sammendrag

  Hovedmålsettingen med prosjektet er at studenter som tar videreutdanning i intensiv sykepleie ved NTNU i Ålesund, skal bli bedre forberedt til praksis gjennom simulering og samtrening med intensivsykepleiere på sykehuset. Formålet med dette er at: 1) Studenter og praksisveiledere blir bedre kjent med hverandre, før studentene blir kastet ut i en hektisk hverdag i klinikken.2) Praksisfeltet vil kunne påvirke innholdet utdanningen med gode og relevante innspill til scenarier, slik at utdanningstilbyder lettere kan tilpasse utdanningen etter praksisfeltets behov. 3) Økt samarbeid og tilknytning mellom NTNU i Ålesund og praksisfeltet kan forberede studentgruppens praksiserfaring gjennom simulering og samtrening med praksisfeltet (intensivsykepleiere ved intensivseksjonen, Helse Møre og Romsdal HF deltar) i trygge og kontrollerte omgivelser. 4) Videre ønsker man at erfaringene fra dette pilotprosjektet brukes til å utvikle et undervisningsopplegg, som kan brukes videre til flere studieretninger innen sykepleie. Dette kan bidra til økt samtrening mellom praksisfelt og studenter. Fra helseforetaket/Intensivseksjonen ønsker man at prosjektet skal bidra til: 1) Kvalitetssikring og økt pasientsikkerhet, gjennom samtrening i et realistisk scenario. 2) Definering av ulike roller hos de involverte ved akutte/uavklarte pasientsituasjoner (på sikt skal helseforetaket utarbeide en ny prosedyre i EQS, dvs. foretakets elektroniske kvalitetssystem). 3) Økt læring og mestring gjennom samhandling mellom intensivsykepleiere/veiledere og studenter, i trygge omgivelser. 4) Fremtidig rekruttering av intensivsykepleiere til helseforetaket (studenter fra grunnutdanningen).

• Hall-Lord, Marie Louise; Marhaug, Gudmund; Hoffmann, Bjørn; Ballangrud, Randi; Lunde, Birgitta Hansen & Olsen, Marit [Vis alle 10 forfattere av denne artikkelen] (2015). Rapport fra arbeidsgruppe Pasientsikkerhet. NTNU, HiST, Høgskolen i gjøvik, Høgskolen i Ålesund. Fulltekst i vitenarkiv
• Blindheim, Kari; Kirchhoff, Ralf & Dahl, Berit Misund (2014). Helse og læring. Høgskolen i Ålesund. ISSN 9788292186510. Fulltekst i vitenarkiv Vis sammendrag

  Det helsefremmende - og sykdomsforebyggende perspektivet er sentralt i arbeidet mot barn og unge for å utvikle gode oppvekstsvilkår. Det er en sammenheng mellom den enkelte elevs helse, skolemiljø og skoleprestasjoner og det er derfor viktig at skolehelsetjenesten og skolen samarbeider om å styrke elevens helse og læringsmuligheter. Opplevelse av sammenheng (OAS) er et sentralt begrep i Antonovsky sin salutogene helsefremmingsmodell. OAS er ikke det samme som helse, men det er sterkt relatert til helse, spesielt psykisk helse. Lav opplevelse av sammenheng samsvarer med dårlig skoletrivsel. Prosjektets mål var gjennom å kartlegge elevenes helse og læringsvariabler i vid forstand å fremme helse og læring i barne- og ungdomsskolen. Dataene baserer seg på en tverrsnittstudie som ble foretatt 2010. Måleinstrumentet var et spørreskjema som hadde 72 spørsmål angående helse, læring og kontekstuelle faktorer. Utvalget besto av elever på 7. og 10. trinn ved barne- og ungdomsskolene i Ålesund kommune. Totalt 677 elever deltok i undersøkelsen. De fleste elevene mener at de har svært god /god helse, men samtidig rapporterer 8 % av jentene på 7. trinn og 18 % av jentene på 10. trinn at de har hodepine mer enn en dag i uken. 22 % av jentene på 10. trinn har vondt i skuldrer og nakke en dag i uken og 10 % hver dag. 26 % av jentene på 7. trinn og 28 % av jentene på 10. trinn har vansker med å sove fra en gang i uken til hver dag. For guttene er frekvensen av hodepine og vondt i skuldrer og nakke noe lavere, men 14 % av guttene på 10. trinn har søvnproblemer mer enn en gang i uken. En betydelig andel av elevene føler seg stresset og stresset øker med alderen. De fleste føler seg glade, men det er også en del som føler seg lei og sliten og det øker med alder. 53 % av elevene på 7. trinn og 44 % av elevene på 10. trinn ser frem til å gå på skole de fleste morgenene. Det er viktig å merke seg at 25 % av elevene på 7. trinn og 30 % av elevene nesten aldri eller aldri gleder seg til å gå på skolen, men det kommer ikke frem av studien hva som er grunnen til det.

• Kirchhoff, Ralf (2013). Tyske sykehusleger i Norge i et institusjonelt perspektiv. Universitetet i Bergen. ISSN 9788230823477. Fulltekst i vitenarkiv Vis sammendrag

  The institutional logics perspective implies that institutional logics are socially constructed, can be reproduced or changed through political decisions, and may work as institutional templates for states, organizations, and professions. In the thesis this analytical framework is used to analyze changes, in the period 1991–2008, in institutional logics in the German and Norwegian hospital sectors. Possible changes in and influence of institutional logics constitute the main research questions in the thesis: 1. What characterizes the development of institutional logics in Norwegian and German hospital sector in the period 1991 - 2008? To what extend are professional logics strengthened or weakened in relation to market logics? 2. To what degree can differences in primary institutionalization, together with other factors, have significance for hospital physician’s perception of organizational commitment, psychosocial work climate, and professional competence? The starting point of the first question is the manifestation of New Public Management (NPM) in the German and Norwegian hospital sectors. The relative presence of NPM in both countries is used as an indicator to judge whether professional logics are challenged or weakened. This analysis is based on a comparison and discussion of reforms that in the literature and thesis is linked to NPM. The second question discusses results from a national survey that was completed in Norway in spring 2009. Here, the answers of German hospital physicians (experimental group, n=338) were compared with the answers of Norwegian hospital physicians (control group, n=287). The thesis shows changes in institutional logics in both countries. During this period, professional logics are substantially more weakened in Norway when compared with that in Germany. As Norway, Germany has improved patient’s legal rights, introduced a new payment system based on Diagnosis Related Groups, and imposed mandatory total quality management systems in the sector. In Germany, these changes were introduced and legally approved by the federal government in the beginning of the 2000s. Norway introduced likewise reforms in the mid-1990s. A major distinction between Norway and Germany is that Germany has not conducted overarching structural reforms in the sector that break with established management and governance traditions. In contrast to the development in Germany, changes in Norway are evaluated as a more pronounced break with established management and governance traditions. This process started in Norway approximately in the 1980s. Professional logics weakened further in Norway beyond 1990 and 2000s, as the state took a more active role in the governance and management of hospitals. Particularly, the introduction of unified management in 1999 and the hospital reform in 2001 are interpreted as indicators for weakening professional logics in the Norwegian hospital sector. Results in the thesis indicate that German physician’s primary institutionalizations, and other factors, have some impact on German hospital physician’s organizational commitment, psychosocial work climate, and professional competence. I found statistically significant differences between the experimental and the control group in the areas that were examined. The results also indicate that the duration of German physician’s employment in Norwegian hospitals had relatively little importance for the investigated phenomena (Kirchhoff, 2010, 2011, 2012). The results indicate that German hospital physicians in Norway experience no greater challenges in adapting to changes in the Norwegian hospital sector, when compared with Norwegian hospital physicians in the control group. On the contrary, physicians in the experimental group score on average higher on perceived organizational commitment (Kirchhoff, 2011), experience less problems with time pressure (Kirchhoff, 2010), and have a perceived higher orientation to be up-to-date in medicine (Kirchhoff, 2012), when compared with Norwegian hospital physicians in the control group. The thesis provides new knowledge about German hospital physicians in Norway, which for many years has been numerically the largest group of foreign physicians in Norway.

• Kirchhoff, Ralf (2007). Konfirmasjonspenger : en undersøkelse om ålesunderes forhold til konfirmasjonspenger. Høgskolen i Ålesund. ISSN 9788292186367. Fulltekst i vitenarkiv
• Kirchhoff, Ralf (2002). Hvorfor valgte de HIÅ som studiested? : Studiestart 2002/2003. Høgskolen i Ålesund. ISSN 9788292186152. Fulltekst i vitenarkiv
• Kirchhoff, Ralf (1996). Kandidatundersøkelse - høgskolene i Finnmark, våren 1994. Høgskolen i Finnmark. ISSN 9788275411967. Fulltekst i vitenarkiv
• Kirchhoff, Ralf (1990). Frikommuneforsøket - En analyse av arbeidstakerorganisasjoners deltakelse og gjennomslag i offentlig prøvevirksomhet. Universitetet i Bergen. Fulltekst i vitenarkiv

Se alle arbeider i NVA