Barthold Vonen bids farewell.

The cardboard boxes have been in place in the director's office for a few weeks already. Little by little, they are being filled up. A couple of boxes with books, diplomas, pictures, and other memories. A couple of boxes with papers and reports that are to be discarded.

On Friday, 24th November, Barthold Vonen turns 70, and from 1st December, he looks forward to retirement at home in Skien.

Man with Opinions

A humourless organisation that could not meet for work meetings at a quarter past eight. This is how Barthold Vonen succinctly describes his first encounter with SKDE as director. In his usual manner, he does not hold back his opinions, much to the likely dismay of many.

— I can't possibly write that?
— Yes, we can! I must be able to speak freely.

He believes in being clear, even if it may irritate some. He further explains that after many years working in hospitals, he was used to starting work early. He was therefore extremely surprised when the employees at SKDE felt that a quarter past eight in the morning was too early for meetings. The director's job literally had a somewhat heavy start. Eventually, things settled down, and now he is daily inspired by his colleagues and the work being done.

— I have been allowed to sit here and not engage in micromanagement. And we have been fortunate with the recruitment of talented people. You know, you can sense where the ceiling is, where the boss's wings are. And being allowed to be here, and not trying to impose wings over the talented people, but letting them carry on and see how they can grow. Leading SKDE has truly been a joy for me. It is extremely important for me to say that.

SKDE in Constant Development

When Barthold Vonen began as SKDE director in 2016, he received three assignments from the then director of Health North, Lars Vorland. The first was to develop SKDE's research component, the second was to enhance international collaboration, and the third was to improve cooperation within SKDE.

— What I am absolutely certain of is that today we are a more unified and collaboratively working organisation than we were. The reason we did not collaborate more across SKDE previously was that we did not have many tasks where it suited to work that way. This has changed, and we have also evolved as an organisation. I think that is good. Regarding internationalisation, we had previously collaborated with a professional environment in Spain before my time. Then we established a close collaboration with the John Wennberg environment in the USA, which has developed to the point where SKDE will now host the international Wennberg conference (WIC) in 2024. That must be seen as a sign that at least things have moved in the right direction. The research section was established in 2022, and we have so far invested a lot of resources in acquiring research data. We still have some way to go before we can be said to have high research output as a centre, but we are on our way, he explains.

What would he have liked to have done or worked more on at SKDE, but did not manage during his time as director? He thinks for a moment before answering:

— I would have liked to have had a greater focus on the normative. That is to say, what is the correct target level for the services we analyse? It turns out that there has been a lack and a clear weakness in the health atlas that we cannot say anything about what the correct level is. One can have low or high rates in the use of a health service, and it can vary greatly – up to six times the difference in rates for a service. Then we should have said something more than that it is merely unjustified or unwanted variation. We have not dared to take it all the way, believes Barthold Vonen.

Award for Openness and Patient Safety Work

Before he became director at SKDE, he was the medical director at Nordland Hospital in Bodø for five years. There, he was involved in a major initiative on patient safety work, which resulted in him receiving the national patient safety award in 2014.

Barthold Vonen was also one of two winners of the Communications Association's Openness Award in 2014. He received the award for being a pioneer in systematic openness work that has led to all hospitals now publicly reporting serious incidents. The background was that Nordland Hospital had experienced a number of malpractice cases. One of these involved misdiagnosis in a mass screening programme for cervical cancer. Cell samples that contained cancer cells had been interpreted as normal. As medical director, he had to stand at the forefront and explain to the media what had gone wrong.

Now he has a fairly relaxed relationship with collaborating with journalists. He finds it far worse to be a surgeon and make mistakes, or to lose his patients, than to be in a media storm.

— When I have failed in serious patient treatment, where I perhaps should have succeeded, I find that has been the heaviest experience in my professional life. As a director, you are responsible, but you have not done the job yourself. It is not your own craft, therefore it has been easier to take that responsibility, even though system failures are very serious for those affected.

Thought of Becoming a Supply Teacher

He remembers well the moment he decided to become a doctor. The year was 1973 and it was spring. The idea was planted in a conversation with a relative while they were taking a walk around the NKL warehouse at Langnes. He thus abandoned his original idea of becoming a supply teacher. Even then, it was not easy to get into medical school. With an "extremely modest A-level" as he puts it, he had to spend three years accumulating study points before he was accepted. In the meantime, he worked as a porter and studied pedagogy.

Over the years, he also obtained a doctorate and became a specialist in gastro surgery. A time he remembers with great joy was when he worked under and in a hospital led by Knut Schrøder (formerly RiTø, now UNN).

— It was a continuous upturn! The only thing you needed to do was to keep going and then ask for forgiveness. I received a lot of support for ideas and things we were working on. Growing up, professionally speaking, in that working environment — and with the leaders I had – was an encouraging time. We succeeded in some things, but not in everything. I learned that one should aim for the stars, and then perhaps only reach the treetops, but that was certainly much better than the starting point.

Radical Report Was Burned

During the 1990s, he became involved in health planning. When the then Minister of Health, Werner Christie, in 1995 proposed that each health region should create its own health plan, Barthold Vonen joined the secretariat for the regional health and social committee. In 1997, the committee presented a rather radical plan for the somatic specialist health service in the north. It proposed that there should be a common regional ownership for the hospitals, which was realised in the form of the Health Enterprise Reform a few years later.

However, in the report, they also proposed to abolish emergency preparedness for five out of eleven hospitals.

— You can imagine that we were "let go"? We had 15 professional groups working and spent a year and a half on this. There were over 100 professionals involved from the region, and we actually only had two dissenting opinions. It was an incredibly fun time where we tried to think anew about neglected groups, and we tried to think about viable on-call teams. We were a bit modern and at the forefront.

— It was not well received?
— No, are you mad. The report was accepted in Troms, but rejected in both Finnmark and Nordland. There it was dismissed or not even considered. It was actually deemed so controversial that the remaining copies were burned under the auspices of the county health directors. You can certainly write that. Imagine that there was a book burning — how modern and dramatic we were.

Compared to Hitler

When the report was on public hearing, the population was not particularly kind in their comments either.

— So what is written and said in today's debate climate... I take it a bit easy. It is nothing new. Everything has happened before.

— But then it is natural to ask about your thoughts on the process currently underway, with proposals for the reorganisation of the specialist health service in Northern Norway?

— I think these are processes that, so far, are securely anchored in a mandate to the regional health enterprise from the owner, the Ministry of Health and Care Services (HOD). It seems that the Minister of Health continues to support this mandate, and I find that very interesting and commendable. I think that if this comes to the Storting, it is hard to say what will happen. But as a mandate from HOD, this has been very solidly anchored work. Of course, one can have opinions about the pace and urgency – but I shall not say much about that – it must take its course, says Barthold Vonen.

Photo: SKDEs arkiv

A Practitioner Becomes a Pensioner

Now retirement life awaits. And the end of the long commute between Tromsø and Skien each week. He will not miss that. The time will be spent on far more enjoyable things.

— I will get to know my grandchildren better. I have had four in the last few years, but I have not lived near them. I won't say that I will exercise more, as that would be silly. I have a facility in Sogn and Fjordane that I manage. But I also have many hobbies, and lately, I have been thinking about attending a year at vocational school for iron and metal. I am unsure if I am actually qualified since I have completed upper secondary school. I am not an academic; I am primarily a practitioner. So I have plenty of practical things to keep me busy.