Flying home from Denmark I wanted to share some thoughts about health and wellness in the community. I visited several more municipalities, where much of the health and wellness work is now happening in Denmark. Max Kruse Director of Varde Municipality explained:

“With the healthcare revolution in Denmark we set up a clear separation of duties between regions and municipalities. We formed 5 regions for health and psychiatric care and 95 municipalities who are responsible for before citizens get sick and after they are out of hospital. Now municipalities pay 20% of the costs whenever our citizens go into the hospital or visit a doctor. Because of the 20% and because of our citizens, we have incentives to take care of our duties.”

Because of the local government reform Varde Municipality established a health center where existing services were co-located and new services were developed, including yearly wellness visits to all citizens aged 75 and older, courses to help citizens learn to live with chronic diseases, to help with depression and anxiety, chronic pain and so on. Supervision is also offered to citizens who have problems with their lifestyle, diet, alcohol or drugs.

According to Margit Thomsen Director of the Health Promotion Center, the aim is to reduce hospitalization, give citizens a better quality of life and help them to come closer to the labor market. She explained: “It doesn’t work to say do it because I am the nurse and I said so. It has to connect to something the citizen cares about.”

Erling Pederson Director of Health and Social Services explained: “Local health issues are a priority for Varde. By far Varde sets the priority on local health. It started with an earlier leader Bent Poulson – he set a high priority and a high ambition for local health. It’s our history. We are a healthy part of Denmark so it was easy to take this step – and we provide the resources to make it possible… We make a written plan for the coming year once a budget has been decided upon by our mayor and city council. We are close to the users and we are very practical.”
Municipalities have become responsible for workforce development as well. According to Erling, “We do rehabilitation for those who are out of work. If you lose your work, you lose your connections with work. Within six months it is very tough to get you back into work. It’s our job to get them healthy and get them back to work again. This takes a lot of collaboration between different people.”

“So now we have the challenge of working across sectors and we don’t know how to do it yet. These people have to get along and work together. Sometimes it works – especially at the beginning of the week [much laughter around the table]. They need to have a good relationship between each other and a good dialogue – they need to know what is going on in the other silos. Otherwise nothing works!”

The desire to promote health and wellness in the community has inspired growing interest in relational coordination in Denmark. RCRC already has several Danish partners who find the RC methodology to be useful – Team Working Life in Copenhagen, Carsten Hornstrup in Aarhus, Bo Vestergaard in Aalborg, the five Danish Regions – and others who are now seeking to join. They’ve joined colleagues from the US, Canada, Netherlands and Australia to learn how to build relationships for high performance.

Many other countries around the world are also seeking to better integrate health and social services to improve the well-being of citizens at a lower cost. This is especially true as the population is aging with fewer people available to take care of our elders. We need to coordinate with each other across our many silos and areas of expertise in order to improve the well-being of citizens, and do it more efficiently. We also need to coordinate with

citizens themselves, who are capable of doing some of this work as members of their own team. Relational coordination offers methods to assess and strengthen coordination across all of these silos.

Given the central role that unions play, I am sometimes asked whether strong unions are positive or negative for relational coordination. As I discovered in the airline industry, relational coordination can work better when there are labor/management partnerships to support it. So it’s not a question of whether unions are strong or weak, but whether they choose to partner with management or not. If unions partner with managers to achieve better relational coordination – and vice versa – this decision could be an important step for any country to transform health and social services to meet the needs of its citizens at lower cost.

In the bigger picture, I am seeing four barriers to building relational coordination.

1) Professional or occupational groups who don’t engage in teamwork with their colleagues because it threatens their own power or sense of identity.

2) Leaders who don’t support teamwork among workers because it threatens their own power or sense of identity.

3) Change agents – organizational development, lean, HR, IT, payment reformers – who don’t engage in teamwork with each other because it threatens their own power or sense of identity.

4) The way we design our structures and our educational institutions to reinforce bureaucratic silos – but these are not so hard to change once the others are resolved.

The good news is that all of these can be addressed and that we are seeing many organizations finding success as they do so! Stay tuned for my next note, about the work that’s happening at the Billings Clinic in Montana over the past six months using positive deviance methods to build high levels of relational coordination in the intensive care unit and beyond. In the meantime, best wishes in your own RC endeavors!