Municipal trust reform: A vague reform without direction, or a window of opportunity?

This paper explores the scope of action in healthcare and public reform processes by analyzing a “trust reform” in which actors were given significant organizational and professional autonomy. The study draws on observation, document reviews, and interviews with 18 actors at various organizational levels in one city district. Employing translational and implementation studies and theories, we find that the open and vague reform creates a space for it to be developed and adapted at the local level, allowing local managers to implement substantial changes within health and care services. This study contributes to discussions on governance and organizational change by proposing a conceptual framework for working with public reforms. Our findings suggest that reform design benefits from being tailored to local reform capabilities through a balance of involvement, support, and specification.