Developing Integrated Care: Towards a development model for integrated care

The thesis adresses the phenomenon of integrated care. The implementation of integrated care for patients with a stroke or dementia is studied. Because a generic quality management model for integrated care is lacking, the study works towards building a development model for integrated care. Based on a systematic approach in which a literature study, a delphi study, a concept mapping study and questionnaire research are combined, a development model for integrated care is created. The model exists of 89 elements of integrated care, which are clustered in nine themes. Also the model describes four phases of development which integrated care services can experience. The model is succesfully empirically validated in 84 integrated care services for stroke, acute myocardial infarct or dementia patients. The model has the potential to serve as a generic quality management model for integrated care services and can be used for monitoring, self evaluation or benchmarking of integrated care services. Also insurers or policy makers could use the model to stimulate integrated care services to further improve and develop their integrated care

Towards a values framework for integrated health services:An international Delphi study

Background In order to organize person-centered health services for a growing number of people with multiple complex health and social care needs, a shift from fragmented to integrated health services delivery has to take place. For the organization of governance in integrated health services, it is important to better understand the underlying factors that drive collaboration, decision-making and behavior between individuals and organizations. Therefore, this article focuses on these underlying normative aspects of integrated health services. This study investigates the values that underpin integrated health services delivery as a concept, by examining the extent to which an initial literature based set of underlying values underpins integrated care and the relevance of these values on the different levels of integration. Methods An international Delphi study with 33 experts from 13 different countries was carried out to examine the initial set of underlying values of integrated health services. In addition, the relevance of the values was assessed on the different levels of integration: personal level, professional level, management level and system level. Results The study resulted in a refined set of 18 values of integrated health services developed in three Delphi study rounds. In addition, the results provided insight into the relevance of these values on the personal level (e.g. ‘trustful’), professional level (e.g. ‘collaborative’), management level (e.g. ‘efficient’) and system level (e.g. ‘comprehensive’) of integration. Some of the values score consistent across the different levels of integration while other values score inconsistent across these levels. Conclusions The Delphi study resulted in an international normative basis for integrated health services delivery as a concept. The values can be used as ingredients for a values framework and provide a better understanding of the normative aspects of integrated health services delivery. Future research could focus on associated behaviors in practice, the relationship between normative integration and governance, and differences between the value priorities of stakeholder groups

Appropriate leadership in nursing home care:A narrative review

Purpose: The purpose of this paper is to synthesize the existing evidence on leadership that best matches nursing home care, with a focus on behaviors, effects and influencing factors. Design/methodology/approach: A narrative review was performed in three steps: the establishment of scope, systematic search in five databases and assessment and analysis of the literature identified. Findings: A total of 44 articles were included in the review. The results of the study imply that a stronger focus on leadership behaviors related to the specific context rather than leadership styles could be of added value in nursing home care. Research limitations/implications: Only articles applicable to nursing home care were included. The definition of “nursing home care” may differ between countries. This study only focused on the academic literature. Future research should focus on strategies and methods for the translation of leadership into behavior in practice. Practical implications: A broader and more conceptual perspective on leadership in nursing homes – in which leadership is seen as an attribute of all employees and enacted in multiple layers of the organization – could support leadership practice. Originality/value: Leadership is considered an important element in the delivery of good quality nursing home care. This study provides insight into leadership behaviors and influencing contextual factors specifically in nursing homes

Integrated care for patients with a stroke in the Netherlands: results and experiences from a national Breakthrough Collaborative Improvement project

PURPOSE: This article considers the question if measurable improvements are achieved in the quality of care in stroke services by using a Breakthrough collaborative quality improvement model. CONTEXT OF CASE: Despite the availability of explicit criteria, evidence based guidelines, national protocols and examples of best practices; stroke care in the Netherlands did not improve substantially yet. For that reason a national collaborative started in 2002 to improve integrated stroke care in 23 self selected stroke services. DATA SOURCES: Characteristics of sites, teams, aims and changes were assessed by using a questionnaire and monthly self-reports of teams. Progress in achieving significant quality improvement has been assessed on a five point Likert scale (IHI score). CASE DESCRIPTION: The stroke services (n=23) formed multidisciplinary teams, which worked together in a collaborative based on the IHI Breakthrough Series Model. Teams received instruction in quality improvement, reviewed self reported performance data, identified bottlenecks and improvement goals, and implemented “potentially better practices” based on criteria from the Edisse study, evidence based guidelines, own ideas and expert opinion. CONCLUSION AND DISCUSSION: Quality of care has been improved in most participating stroke services. Eighty-seven percent of the teams have improved their care significantly on at least one topic. About 34% of the teams have achieved significant improvement on all aims within the time frame of the project. The project has contributed to the further development and spread of integrated stroke care in the Netherlands

Q-methodologie als methode om beleid te beschrijven, te ontwikkelen of te evalueren

Q-methodologie is een nog relatief onbekende onderzoeksmethode, met veel potentieel voor beleidsonderzoek en -analyse. De benaderingen, doelen en onderzoeksvragen in verschillende toepassingen lopen uiteen, maar vertonen ook duidelijke overeenkomsten. In dit artikel beschrijven we de belangrijkste theoretische en analytische bouwstenen van de methode, en een praktijkgericht 10-stappenplan waarmee men snel zelf aan de slag kan met Q-methodologie. Op basis van een aantal toepassingen van Q-methodologie in Nederland en Vlaanderen laat dit artikel op inzichtelijke wijze zien wat Q-methodologie toevoegt aan de toolbox van beleidsonderzoekers. Naast de theoretische achtergrond van de methode biedt deze bijdrage een praktisch stappenplan voor het gebruik van de methode in de praktijk