Sundhedsreformen 2024: Sammenhæng eller knæk i kerneopgaven ’Sundhed’ for kommunerne

Abstract

The thesis explores Health Reform 2024, which introduces changes to the Danish healthcare system aimed at improving proximity, reducing social and geographical inequality, and enhancing continuity in care and treatment. While promising better and more localized healthcare, the reform raises questions about how municipalities' health responsibilities are evolving and the leadership demands to this creates, particularly in smaller municipalities with significant health challenges and limited resources, such as Odsherred Municipality. The reform significantly shifts responsibilities from municipalities to regions, including specialized nursing, advanced rehabilitation, and temporary health and care facilities. This centralization aims to ensure consistency and high-quality in-service delivery while reducing siloed thinking. Concur-rently, health councils are introduced to collaboration between municipalities and regions on local healthcare development. Municipalities retain responsibility for prevention and health promotion by an upcoming public health law aimed at
reducing inequality and enhancing citizen well-being.

The analysis draws on two theoretical frameworks: "The New Synthesis" (Bourgon & Dahl), which identifies four approaches to public value creation: compliance, performance, emergence, and resilience and Weick’s concept of “sensemaking”. These frameworks are used to analyze how the reform’s structure creates new opportunities and challenges for municipal leadership, and how actors in Odsherred Municipality interpret and navigate the reform’s demands and uncertainties in practice. Through document analysis and qualitative interviews with political and administrative leaders as well as key employees, the thesis examines how the reform influences municipal practices. Weick's theory underscores the importance of leaders actively interpreting and creating coherence in a reform that simultaneously decentralizes and centralizes tasks. The transfer of responsibilities to regions generates uncertainty about municipalities’ roles, compelling leaders to clarify roles and provide direction through interpretation and collaboration.

The thesis concludes that municipalities will gain improved frameworks for prevention through the upcoming public health law. However, the reform’s success depends on municipalities' ability to prioritize prevention and health promotion -areas often deprioritized in practice. Weick’s sense-making emerges as a crucial leadership skill in managing complexity and translating reform visions into actions that resonate with employees and citizens. The thesis emphasizes that leadership must balance contradictory demands, ensure coherence in welfare services, and focus on long-term public value creation.