Local management of the COVID-19 pandemic in Norway: a longitudinal interview study of municipality chief medical officers

Abstract

Objective

To explore the experiences and views of Norwegian Municipality Chief Medical Officers (MCMOs) on preparedness, collaboration, and organization during the COVID-19 pandemic to gain insight into local crisis management of value for future pandemic responses.

Design

Longitudinal qualitative interview study. We conducted semi-structured digital interviews with nine MCMOs working in different municipalities in Norway from September to December 2020. Five MCMOs were re-interviewed from January to April 2021. We used thematic analysis to analyze the data.

Results

Through the analysis, three major themes were identified in the material; 1) The view of preparedness changed from being low-priority and dormant to the desire to strengthen preparedness as a permanent measure; 2) The nature of the pandemic forced a change in internal and external communication and collaboration for the MCMOs towards direct dialogue, teamwork and digital networking; 3) The pandemic changed the role and position of the MCMO within the municipal organization. Although most MCMOs were given a leading role in the municipal pandemic response, some MCMOs experienced that they were not positioned to fully exercise their intended role. In our material, de-authorization of the MCMO role seemed to coincide with the increasing size and organizational complexity of the municipality.

Conclusions

The Norwegian pandemic response and outcome have been regarded as successful internationally. Although the MCMOs managed to implement flexible and quick responses facilitated by teamwork, dialogue, and joint sensemaking, they also identified several challenges and shortcomings of the Norwegian pandemic preparedness requiring organizational and financial changes to sustain future health system resilience.

KEY POINTS

• The Norwegian Infection Control Act gave comprehensive responsibility and authority for local COVID-19 pandemic management to the municipalities and the Municipality Chief Medical Officers (MCMOs).

• The MCMOs highlighted several challenges and shortcomings of the municipal crisis preparedness, of which lack of detailed organizational plans was the most prominent.

• Teamwork, digital networking and collective sensemaking seemed to enhance pandemic collaboration and resilience within and across municipalities.

• Most MCMOs gained a leading role at a higher organizational level within the municipality through the COVID-19 pandemic.

• To strengthen future crisis management, arrangements must be made, both organizationally and financially, for preparedness to remain on the agenda even between epidemics and pandemics.

Keywords:

• COVID-19
• qualitative research
• public health
• crisis management
• municipality chief medical officers

Acknowledgements

The authors would like to thank all participating MCMOs. We would also like to thank Sara Sofia Lithèn and Benedikte Olsen Michalsen for their invaluable assistance in the study process.

Ethical approval

The study was presented to the Norwegian Ethical Committee (REK southeast C, ref; 155344) which found the project not to require pre-approval. Data management and safety was approved by the Norwegian Agency for Shared Services in Education and Research (Sikt, ref; 615396).

Disclosure statement

No potential conflict of interest was reported by the author(s).

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

The CovidNor study was funded by the The Research Council of Norway (GRANT number: 312717).