Over the last few decades, the global health care sector has undergone changes that increasingly emphasize and incentivize systemness, often through consolidating or partnering to integrate services. This trend accelerated in 2020—multiple jurisdictions have put forth legislation to promote network formation or reshuffle existing networks in the past 12 months including Saudi Arabia, New Zealand, and Finland.

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We see this as a good thing: systems with partners representing the entire health care spectrum will likely be better positioned to deal with crises and more easily improve the quadruple aim. But too often, political tensions hamper these networks from effectively making decisions. After all, these networks often start as coalitions of the willing. And in that environment, it is a tough sell for a partner to put the needs of a collective above the needs of their own organization. With dozens of parties at the table (some regional networks have upwards of 100 disparate partners), coming to a consensus voluntarily is no small task. And larger or better-resourced partners—usually hospitals—having more political sway than others can lead to a zero-sum atmosphere.

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But one of the pandemic's silver linings was the "low barriers" to collaboration that it afforded us—a common vision and goal, urgency, and general agreement on where to shift resources to support the larger community. To put it bluntly, many partnerships "got out of their own way" during the crisis. One organization from Denmark is worth learning from, as they took the crisis as an opportunity to (literally) de-politicize how they make decisions altogether.

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Danske Regioner (Danish Regions), an Advisory Board member, is an autonomous public body that acts as the representative organization for the country's five regions. (For context, each of Denmark's five regions is governed by elected councilors and has full administrative and planning responsibilities for their area's health care. They own all public hospitals and maintain contracts with primary care physicians and specialists. Danish Regions sits between these regions and the national government and negotiates prices and payment on behalf of the regions, acts as their spokesperson, and is involved in the national and regional strategic planning of health care.)

Before Covid-19, leaders from Danish Regions and the five regions met regularly to discuss regional strategy and lobby the national government for funding or policy changes. These meetings were chaired by a senior leader from Danish Regions or a local politician. In ‘normal times', this worked well to coordinate health care policy within the regional structure.

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But when the pandemic struck, it was clear that the meetings needed to be expanded to include other organizations that were vital to the country's response such as national medical and health agencies, the local government, and the representative primary care association. The meetings became a daily "virtual war room" where radical decisions needed to be made rapidly and the focus had to be on regional operations. Importantly, conflicts between the different agencies and levels of governance had to be avoided to make the decision-making process efficient and fair. 

Once you cede control to practicalities instead of politics, you can make greater progress on achieving what the system really needs

To overcome any potential conflict, Danish Regions installed a mid-level manager from within their organization to facilitate the meetings. This manager was chosen because he didn't bring in his own biased points of view and because he wasn't competing for influence, rather he was focused on one thing—running the meetings with the whole system and the population as the priority. In essence, this completely removed the political lens of the meetings and bypassed contention that would have arisen between different political agencies had any of them been in charge.

According to Danish Regions' CEO, the fact that the facilitator had a financial background didn't matter. Instead, it was that the facilitator was primarily interested in the "practical details" and brought to the table an operational perspective that came from his background in a local hospital. It was always about finding the right solutions to the problems the group had to tackle.

Since the facilitator was installed during the first wave of Covid-19, the meetings were then always centered around the operations and efficiencies of the pandemic response. Due to the decentralized public health structure in Denmark, a huge amount of regional coordination was required to organize mass testing, vaccine distribution, personal protective equipment procurement, and all of the other pandemic demands that need to be addressed. The mid-manager ensured the meetings focused on questions such as, "How can we regionally coordinate testing analysis capacity?" or "Who should we vaccinate if we have leftover doses?" and that practical lens was crucial for the group to make decisions efficiently.

Surprisingly, this change was well received by the other meeting participants too, including multiple CEOs, the heads of the national health agencies, and a representative from the Ministry of Health. It was such a success in fact, that the group has continued to use the mid-level manager as the facilitator moving forward. What was once a temporary solution to mitigate the risk of politicization and inefficiency during a pandemic is now set to become a permanent feature of the regional meetings moving out of the crisis. And this will help the Danish health system focus on what the system actually needs.