Rótin urges state to clarify SÁÁ healthcare leadership

Rótin, an organisation addressing issues affecting women with addiction problems, says the conflict within SÁÁ reflects long-standing weaknesses in the governance of the organisation’s healthcare services, mbl.is reports. It says the state must establish clear boundaries between SÁÁ’s executive board and the professional leadership of Vogur hospital and the organisation’s other healthcare services.

The comments were made in a statement on the situation within SÁÁ. Rótin says the problem cannot be solved simply by replacing managers.

SÁÁ’s executive board dismissed chief executive Ragnheiður Hulda Friðriksdóttir earlier on Wednesday, according to an earlier report. The decision resulted in most of the senior management at Vogur hospital leaving their positions.

Vogur is a hospital

Rótin says it is important to distinguish between SÁÁ as an association and Vogur as a hospital. SÁÁ has a treatment and recovery philosophy rooted in the Twelve Step movement and the Minnesota Model. However, when the association provides healthcare services for the state, those services must meet the same standards of professionalism, quality and safety as other healthcare services.

“Vogur is a hospital,” the statement says.

Rótin refers to research and writings by criminologist Hildigunnur Ólafsdóttir on the strong position of the Twelve Step movement in Iceland. Over time, the movement has become an influential force in the treatment of people with substance use problems and has influenced policy and the development of services.

In Rótin’s view, this history may partly explain why the boundaries between SÁÁ’s board and the professional managers of its healthcare services remain unclear. If the association’s executive board has significant influence over the hospital’s operations without clearly defined authority and responsibility for professional managers, similar conflicts could arise again, it says.

Need to strengthen expertise and education

Rótin also points out that none of the current members of SÁÁ’s executive board has a university degree in a healthcare field. Two hold professional qualifications as alcohol and substance use counsellors. Rótin says this is not in itself a problem if there is a clear separation between the board’s role and the professional role of the healthcare services.

The statement also refers to a 2024 assessment by Thomas Kattau for the Ministry of Health, which found limited capacity, staff shortages and a lack of specialised personnel in the services. Education and staff expertise therefore need to be strengthened, Rótin says.

People seeking treatment for substance use have the right to services based on their needs, professional assessment and the best available knowledge, according to Rótin. The treatment philosophy of individual associations should not determine what treatment people receive.

Rótin also says it is important to ensure a range of treatment options and prevent one association from becoming so dominant in the field that other perspectives are excluded.

Rótin says it has sent a request to the minister of health calling for a special review of the governance structure of SÁÁ’s healthcare services. The aim is to ensure professional independence, clear responsibility, service quality and patients’ rights.

“Otherwise, we risk finding ourselves in the same place again in a few years, with new people but the same systemic problem,” the statement says.