6. Methodological approach and procedure
Based on the four system levels, the network has investigated the root causes of the identified challenges, with a particular focus on why coordinating complex welfare services across sectors remains so challenging.
Examination of micro, meso and exo levels
A selection of case municipalities was examined in more detail through a series of workshops at the micro, meso and exo levels. The purpose was to shed light on how the generic problems are expressed in practice and how the municipalities attempt to address them through organisation, cooperation and prioritisation.
During the autumn of 2024, workshops were conducted in Norway, Sweden, and Denmark. Greenland, Iceland, the Faroe Islands, and the Åland Islands were unable to allocate resources to host workshops. Instead, their perspectives were incorporated through a validation process, where they contributed input to the findings, as described below.
Case selection and workshop participants
Norway, Sweden, and Denmark each selected one municipality based on a set of criteria, including population size, socioeconomics and geographical accessibility. To ensure comparability, municipalities at extremes of these criteria (e.g. the smallest or largest in the country) were excluded.
The chosen workshop format, focusing on one municipality in each country, had a consequence for representativeness. The network attempted to take this into account by choosing an “average municipality” as described above. Furthermore, the risk of bias was reduced across countries, since the findings are not based on a single case, but on a pattern of findings from different national contexts.
In each selected municipality, relevant employees, middle managers and top managers were invited to represent the exo level. It was also relevant that several hierarchical levels across the different services/administrations were represented. Additional relevant service providers were invited to represent the meso level. Finally, local user and/or relative representatives were invited to contribute by sharing experiences and insights from users at the micro level.
Structuring the workshop day
The workshop used an iceberg model to explore on the underlying causes of the identified challenges. This methodological approach was decided with the involvement of the National Institute of Public Health in Denmark. The model enabled the challenges to be assessed from four different levels:
- Visible challenges – What is happening? What can we see/observe?
- Practice (working methods, processes, actions, patterns, etc.) – What is the basis for the challenges?
- Rules and structures (policy, organisation, management, etc.) – How are the challenges affected by the organisation’s organisation, priorities, economy, rules?
- Mental models and culture (actions, mindsets, culture, etc.) – Which points of view, assumptions, values and mindsets govern the system?
Figure 3 illustrates that the hypotheses are analysed from an iceberg with the aim of examining the root causes of the visible challenge.
Based on experiences from Norway, the first country to host a workshop, an empathy mapping exercise was later introduced to gather more data at a micro level.
National analyses of findings from the workshops
The data collected from the workshops were structured, coded, categorised and analysed using the same procedure in each country. This approach enabled the compilation of findings across the Nordic countries.
Each country began by structuring the data collected from workshops held in the case municipalities. The starting point was the various statements, either something direct quotes from the participants or interpretations of what had been said. The data structuring was based on the same template with fields for notes at each of the three system levels.
Each country then proceeded to code and categorise its own material. To enhance reliability, each employee in the different countries conducted individual coding before comparing their results. The initial codes were based on categories agreed upon by the working group, but there was also an openness to emerging categories, allowing empirical data to possibly show new perspectives.
The material was divided into ten categories based on the coding:
- Unequal power relations
- Alienation
- Lack of collaboration
- Anxiety and fear
- Bureaucracy
- Overload
- Unclear organisation
- Prioritisation
- Unequal conditions
- Positive experiences
- Other
Finally, each country summarised the material using a matrix that reflected what the data revealed within each of the ten themes, across the micro, meso, and exo levels. Each of the 30 fields in the matrix contained one to three meaningful sentences that distilled the statements assigned to the respective codes at each system level. The three national analyses were subsequently validated by the participating case municipalities.
Cross-Nordic compilation and validation of Greenland, Iceland, the Faroe Islands, and the Åland Islands
The working group developed a draft for a cross-Nordic compilation based on the three national analyses. It consisted of two core elements – a shared matrix derived from the three national analyses, and a common Nordic challenge overview at the micro, meso and exo levels.
The draft for the cross-Nordic compilation formed the basis for validation in the other countries of the network (Greenland, Iceland, the Faroe Islands, and the Åland Islands). The purpose was partly to validate the main points in the cross-Nordic compilation, including whether the trends were also recognisable in the Greenlandic, Icelandic, Faroese and Ålandic contexts, and partly to supplement the cross-Nordic compilation with any unique perspectives from the local contexts that should also be included in the mapping.
It turned out that these countries were also facing similar challenges, and that the overall picture was, in other words, highly recognisable.
Network discussion of findings at the micro, meso and exo levels
The discussions at the network meeting in Torshavn on 1 May 2025, prioritised the preliminary findings from the mapping, and a common point was that the communication of the results should focus on the connections between the system levels to understand how they interact. The discussion condensed the preliminary findings at the micro, meso and exo levels and resulted in five headings.
Examination of macro level
In addition to the workshops held in the case municipalities, Norway, Sweden and Denmark have also explored perspectives at the macro level. The coverage was carried out at a meeting with key national stakeholders in Sweden and Denmark, respectively. The meetings focused on the five headings that the network had agreed on and a discussion of the challenges at the macro level.
In Sweden, the Swedish Association of Local Authorities and Regions (SALAR) and the National Board of Health and Welfare participated. In Denmark, Local Government Denmark (KL), Danish Regions, the The Danish Agency for Education and Quality (STUK), the Danish Health Authority, and the Danish Authority of Social Services and Housing participated.
In Norway, several national initiatives have addressed challenges in coordinating complex welfare services. A cross-sectoral collaboration involving ministries and 13 national agencies aims to improve service integration for vulnerable children and youth by building on previous efforts and promoting co-creation with key stakeholders. Regular workshops and collaborative processes ensure ongoing dialogue and shared understanding. Given the well-established structures and shared knowledge, organising additional workshops with the same participants was considered unnecessary. Therefore, the macro level perspectives from Norway in other words stem from discussions in this cross-sectoral collaboration.
Desk research on approaches to holistic welfare services
Norway, Sweden and Denmark conducted desk research to explore how each country has sought to strengthen cross-sectoral cooperation through legislation and other national initiatives. A primary focus was on publications from the period 2020–2025, although earlier materials were also included when relevant. However, the period is extended to include older publications, if there have been important national campaigns or similar launched before 2020.
In the three countries, the search targeted reports and articles with a practice-oriented focus. Specifically, the research was limited to grey literature, which is understood as publications from state actors and authorities, from regional and municipal actors and from interest organisations, etc. Within this framework, it is ensured that the following type of materials were included:
- Knowledge base: Reports from research, evaluations, studies, and relevant literature.
- National guiding documents: Such as white papers, national strategies, and policy reports.
- National development initiatives: Including ongoing or completed reforms, programs, and measures.
Keywords like holistic, coordinated and cohesive efforts, interdisciplinary and cross-professional coordination and process were used in the search. Based on the searches, the most relevant and most interesting publications were selected in relation to the focus of the mapping. A maximum of 30 publications per country was set as the selection limit.