Collaboration in a new wrapping: A qualitative case study of governance capacity and legitimacy in Norwegian Healthcare Communities

Focusing on varying capacities and forms of legitimacy, this qualitative case study examines the Norwegian concept of Healthcare Communities (Helsefellesskap), aiming to enhance coherence and resource efficiency in health services. Based on documents and interviews with 13 key informants, the study reveals that while county-wide collaboration committees struggle with conflicting interests, local committees demonstrate greater capacity and legitimacy. Despite some variation, key enablers include dialogue that fosters mutual understanding and commitment, decision-making authority, and relational bonds developed through regular interaction. Concrete projects may shift the focus from questioning collaboration to making it work. The findings are relevant for policymakers and health leaders, highlighting the impact of aligning collaboration with stakeholder interests, and enabling local adaptation. The study contributes to the academic discussion by deepening the understanding of how collaborative governance can balance centralized policy frameworks with decentralized, flexible practices.