On March 15 2021 Master of valuebased leadership Kjersti Wendt at Institute of Clinical Medicine defended a on thesis Vascular Disease Management: Knowledge Development and the Politics of Organizational Adaptation for the degree of PhD (Philosophiae Doctor). Adjudication committee
First opponent: Professor Emeritus Mats Brommels, Karolinska Institute, Stockholm, Sweden. Second opponent: Adjunct Professor Rebecka Hultgren, Karolinska Institute, Stockholm, Sweden. Third member and chair of the evaluation committee: Professor Kristin Margrete Heggen, Institute of Health and Society, University of Oslo. Chair of defence
Professor II Marit Lieng, Institute of Clinical Medicine, University of Oslo. Principal Supervisor Professor II Erik Fosse, Institute of Clinical Medicine, University of Oslo 

Summary

New treatment options mean less pain and shorter hospitalization for many patients. For the hospitals, new treatment strategies often require technological investments and organizational change. This thesis is based on two quantitative studies with data from the Norwegian Patient Registry and one qualitative study with material from documents, interviews and field conversations. The thesis describes trends in numbers of treatments in the area of vascular disease in Norway (2001-2014) and the related organizational decision-making processes at a regional and local health care level (2007-2019). There was an increase in total vascular surgery rates for intact abdominal aortic aneurysms while rates of ruptured abdominal aneurysms decreased. Total lower extremity revascularisation rates increased. Open surgery rates decreased while endovascular procedure rates increased in all these groups. There were regional variances in these trends. The number of vascular centers performing abdominal aortic repairs decreased. Regions organized with few and large centers performed the highest percentages of endovascular aneurysm repairs. In patients with peripheral arterial disease, major amputation rates declined. In the decision-making processes, the managers and their professional advisers aimed to centralize the vascular treatments based on medical and economical scale advantages. Local groups of professionals, patients, lay people and politicians only wanted to adjust the existing systems. The managers had to review the power configuration. At the regional level, they revoked their centralizing plans. At the local level, the process developed into an “escalating process of indecisiveness”.