Implementing innovative health service models in existing service systems is complicated and context dependent. Flexible assertive community treatment (FACT) is a multidisciplinary service model aimed at providing integrated care for people with severe mental illness. The model was developed in the Netherlands and is now used in several countries, such as Norway. The Norwegian service system is complex and fragmented, with challenges in collaboration. Limited research has been performed on FACT teams and other new integrative health service models as part of such systems. However, such knowledge is important for future adjustments of innovation processes and service systems. Our aim was to explore how FACT teams are integrated into the existing formal public service system, how they function and affect the system, and describe some influencing factors to this. We sought to address how service providers in the existing service system experience the functioning of FACT teams in the system. Five focus group interviews were undertaken 3 years after the FACT teams were implemented. Forty service providers representing different services from both levels of administration (primary and specialist healthcare) from different Norwegian regions participated in this study. Team leaders of the FACT teams also participated. Service providers were recruited through purposeful sampling. Interviews were analysed using thematic text analysis. The analysis revealed five main themes regarding FACT teams: (1) They form a bridge between different services; (2) They collaborate with other services; (3) They undertake responsibility and reassure other services; (4) They do not close all gaps in service systems; and (5) They are part of a service system that hampers their functioning. The FACT teams in this study contributed to positive changes in the existing service system. They largely contributed to less complex and fragmented systems by forming a bridge and undertaking responsibility in the system and by collaborating with and reassuring other services; this has reduced some gaps in the system. The way FACT teams function and needs of the existing system appear to have contributed positively to these findings. However, complexity and fragmentation of the system partly hamper functioning of the FACT teams.

中文翻译：

---

灵活自信的社区治疗团队可以改变复杂而分散的服务系统：服务提供者的经验


在现有服务系统中实施创新的卫生服务模式是复杂的且依赖于具体情况。灵活自信社区治疗（FACT）是一种多学科服务模式，旨在为患有严重精神疾病的人提供综合护理。该模型是在荷兰开发的，现已在挪威等多个国家使用。挪威的服务体系复杂且分散，协作面临挑战。对 FACT 团队和作为此类系统一部分的其他新的综合卫生服务模式进行的研究有限。然而，这些知识对于未来创新流程和服务系统的调整非常重要。我们的目的是探讨FACT团队如何融入现有的正式公共服务体系，他们如何运作并影响系统，并描述一些影响因素。我们试图解决现有服务系统中的服务提供商如何体验系统中 FACT 团队的运作。 FACT 团队实施 3 年后，进行了五次焦点小组访谈。来自挪威不同地区的代表来自两个管理级别（初级和专科医疗保健）的不同服务的四十家服务提供商参与了这项研究。 FACT团队的团队领导也参加了。服务提供者是通过有目的的抽样招募的。使用主题文本分析对访谈进行分析。分析揭示了 FACT 团队的五个主要主题：（1）它们在不同服务之间架起了桥梁； (2) 与其他服务机构合作； （三）承担责任并保证其他服务； （四）服务体系不完善； (5)它们是妨碍其运作的服务系统的一部分。 本研究中的 FACT 团队为现有服务系统的积极变化做出了贡献。他们通过在系统中搭建桥梁并承担责任，以及与其他服务部门合作并保证其安全，在很大程度上为降低复杂性和分散性的系统做出了贡献；这减少了系统中的一些差距。 FACT 团队的运作方式和现有系统的需求似乎对这些发现做出了积极贡献。然而，系统的复杂性和碎片化在一定程度上阻碍了 FACT 团队的运作。