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Anne Kathrine Larssen Bygg Og Eiendoms Betydning for Effektiv Sykehusdrift Buildings' Impact on Hospital Effectiveness

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Anne Kathrine Larssen Bygg Og Eiendoms Betydning for Effektiv Sykehusdrift Buildings' Impact on Hospital Effectiveness Doktoravhandlinger ved NTNU, Anne Kathrine Larssen Anne Kathrine Larssen Bygg og eiendoms betydning for effektiv sykehusdrift Buildings' Impact on Hospital Effectiveness ISBN 978-82-471-2886-2 (trykt utg.) ISBN 978-82-471-2888-6 (elektr. utg.) ISSN 1503-8181 Doktoravhandlinger ved NTNU, ved Doktoravhandlinger NTNU universitet philosophiae doctor philosophiae Avhandling for graden for Avhandling Norges teknisk-naturvitenskapelige Norges Institutt for bygg, anlegg og transport bygg, anlegg for Institutt Fakultet for ingeniørvitenskap og teknologi ingeniørvitenskap for Fakultet Anne Kathrine Larssen Bygg og eiendoms betydning for effektiv sykehusdrift Buildings' Impact on Hospital Effectiveness Avhandling for graden philosophiae doctor Trondheim, juni 2011 Norges teknisk-naturvitenskapelige universitet Fakultet for ingeniørvitenskap og teknologi Institutt for bygg, anlegg og transport NTNU Cdg\ZhiZ`c^h`"cVijgk^iZch`VeZa^\Zjc^kZgh^iZi 6k]VcYa^c\[dg\gVYZce]^adhde]^VZYdXidg ;V`jaiZi[dg^c\Zc^©gk^iZch`Ved\iZ`cdad\^>KI >chi^ijii[dgWn\\!VcaZ\\d\igVchedgi 6ccZ@Vi]g^cZAVghhZc >H7C.,-"-'"),&"'--+"'ign`iji\# >H7C.,-"-'"),&"'---"+ZaZ`igji\# >HHC&*%("-&-& 9d`idgVk]VcYa^c\ZgkZYCICJ!'%&&/&,% Ign`iVkIVe^gJiign`` Bygg og eiendoms betydning for effektiv sykehusdrift PhD avhandling Anne Kathrine Larssen Fakultet for ingeniørvitenskap og teknologi, institutt for bygg, anlegg og transport NTNU 2011 Larssen, A. K. – Bygg og eiendoms betydning for effektiv sykehusdrift Forord Dette PhD – arbeidet har ført meg ut på en lang reise, både i tid og i faglig utvikling, fra oppstarten for nærmere 10 år siden til i dag. Underveis har jeg fått muligheten til å fordype meg i interessante tema og fått mange nye bekjentskaper jeg setter stor pris på. Reisen har tatt så lang tid av flere årsaker, blant annet familieforøkelser, bortfall av opprinnelig finansiering, tidkrevende prosesser med å få etablert FOU-prosjekter med de rette aktører og finansiering, og en ikke alltid like lett kombinasjon med jobb. De færreste velger reisemål helt tilfeldig, heller ikke jeg. Min interesse for forvaltning av bygg og eiendommer ble vekket gjennom mitt arbeid i Oslo kommune på 1990 – tallet, der jeg deltok i forberedelsene til det som senere ledet til opprettelsen av fire kommunale eiendomsforetak. Senere gikk jeg over i rådgivende virksomhet innen bygg og eiendomsforvaltning i Multiconsult. En sterk motivasjon for valg av arbeidsfelt har vært et ønske om å gjøre noe samfunnsnyttig, noe resultatene fra dette PhD-arbeidet forhåpentlig vil kunne bidra til. Studiene i PhD arbeidet er i stor grad gjennomført som del av pågående forsknings- og utviklingsprosjekter i regi av bygg og eiendomsforvaltningsmiljøet i Multiconsult og støttet av Norges forskningsråd. FOU-prosjektene, og også dette PhD-arbeidet, er rettet mot praktisk problemløsning, kunnskapsutvikling og -formidling. Min egen sterke kobling til fagområdet og fagmiljøet bygg og eiendomsforvaltning i Multiconsult påvirker naturlig nok egen forståelse og ståsted i forhold til de problemstillingene som dette PhD-arbeidet omhandler. Multiconsults FOU-team har til enhver tid bestått av 5-7 personer som har vært involvert i prosjektene i varierende grad. Samtlige prosjekter har i stor grad involvert representanter fra bygg og eiendomsforvaltningen i samarbeidende organisasjoner, som helseforetak og regionale helseforetak, og andre ressurspersoner og organisasjoner innen aktuelle fagområder, som sykehusplanleggingsmiljøet i Sintef Teknologi og Samfunn. Jeg vil rette en stor takk til alle de engasjerte personer som har vært diskusjonspartnere, respondenter i studier og bidragsytere i case eller på annen måte i dette PhD-arbeidet! PhD arbeidet er tilknyttet NTNU, Ingeniørvitenskap og teknologi, hvor begge mine veiledere har arbeidet i den perioden dette PhD-arbeidet har pågått - Marit Støre Valen som instituttleder og Svein Bjørberg som professor II. Svein Bjørberg er den som opprinnelig tok initiativ til å igangsette dette PhD-arbeidet, og har også vært prosjektleder for FOU-prosjektene dette PhD-arbeidet er koblet opp mot. En stor takk til dere begge for inspirasjon, faglig støtte, oppmuntring og god veiledning! Jeg må også få rette en stor takk til Multiconsults ledelse som har latt meg få muligheten, bidratt økonomisk og tilrettelagt for gjennomføring i kombinasjon med jobb. Blant mine næmeste kolleger vil jeg spesielt trekke frem Kjell Bjarte Kvinge, Anders Larsen og Svein Bjørberg (igjen) – dette arbeidet er like mye deres – tusen takk for godt samarbeid, uvurderlig støtte og samhold i alle disse årene! Maken til gode kollegaer og dyktige fagpersoner skal man lete lenge etter! Også mine øvrige kolleger i bygg og eiendomsforvaltningsmiljøet i Multiconsult fortjener en stor takk for sin tålmodighet med meg i innspurten av avhandlingen! Takk også til mine foreldre, bror og gode venner – nå kommer bedre tider! Som nevnt har min familie økt i løpet av denne reisen - en spesielt stor takk til to viktige personer; Emil og Kornelia for deres evne til å gi de grå dagene glede, og for deres rause overbærenhet med en stadig oftere fraværende mamma. Og sist, men allikevel først og fremst – kjære Andreas - uten din støtte og solide innsats for familiemaskineriet gjennom lang tid hadde denne avhandlingen aldri blitt noe av! Nå er det din tur! Anne Kathrine Larssen, Oslo 20.02.2011 1 Larssen, A. K. – Bygg og eiendoms betydning for effektiv sykehusdrift 2 Larssen, A. K. – Bygg og eiendoms betydning for effektiv sykehusdrift FORORD ............................................................................................................................................................................. 1 SAMMENDRAG .................................................................................................................................................................. 9 SUMMARY IN ENGLISH .................................................................................................................................................... 17 1. INNLEDNING ........................................................................................................................................................... 25 1.1 BAKGRUNN ............................................................................................................................................................... 25 1.2 PROBLEMSTILLINGER OG MÅLSETNING FOR FORSKNINGSPROSJEKTET ....................................................................................... 28 1.2.1 Målsetning ....................................................................................................................................................... 31 1.2.2 Forskningsspørsmål .......................................................................................................................................... 31 1.2.3 Avgrensninger .................................................................................................................................................. 34 1.3 FORSKNINGSTILNÆRMING OG DESIGN AV FORSKNINGSPROSJEKTET ......................................................................................... 34 1.3.1 Egen og forskningsmiljøets kontekst ................................................................................................................ 34 1.3.2 Forskningsfilosofi og paradigme ...................................................................................................................... 34 1.3.3 Type forskning og forskningsmetoder .............................................................................................................. 36 1.3.4 Konstruktiv forskningsmetode (Constructive research) .................................................................................... 39 1.3.5 Design av forskningsprosjektet ........................................................................................................................ 41 1.3.6 Kvalitetskriterier for forskningsarbeidet ........................................................................................................... 43 1.3.7 Avhandlingens oppbygging .............................................................................................................................. 44 2. TEORETISK RAMMEVERK ........................................................................................................................................ 45 2.1 INNLEDNING .............................................................................................................................................................. 45 2.2 SYKEHUSENES UTVIKLING OG FREMTIDIGE TRENDER/UTFORDRINGER ....................................................................................... 45 2.2.1 Sykehusenes utvikling i Norge .......................................................................................................................... 45 2.2.2 Spesialisthelsetjenesten i Norge i dag .............................................................................................................. 46 2.2.3 Kjennetegn ved sykehus fra ulike tidsperioder ................................................................................................. 48 2.2.4 Trender innen synet på pasientbehandling ...................................................................................................... 59 2.2.5 Pasientforløp .................................................................................................................................................... 60 2.2.6
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