19 research outputs found
Values of Integrated Care: A Systematic Review
Introduction: Although substantial generic knowledge about integrated care has been developed, better understanding of the factors that drive behaviour, decision-making, collaboration and governance processes in integrated care networks is needed to take integrated care forward. To gain more insight into these topics and to understand integrated care in more depth, a set of underlying values of integrated care has been developed and defined in this study. Theory and methods: A systematic literature review was conducted to identify the underlying values of integrated care. Values theory was used as a theoretical framework for the analysis. Results: This study identified 23 values in the current body of knowledge. The most frequently identified values are âcollaborativeâ, âco-ordinatedâ, âtransparentâ, âempoweringâ, âcomprehensiveâ, âco-producedâ and âshared responsibility and accountabilityâ. Discussion and conclusion: The set of values is presented as a potential basis for a values-driven approach to integrated care. This approach enables better understanding of the behaviours and collaboration in integrated care and may also be used to develop guidance or governance in this area. The practical application of the values and their use at multiple levels is discussed. The consequences of different stakeholder perceptions on the values is explored and an agenda for future research is proposed
Decision-Making Dilemmas within Integrated Care Service Networks: A Systematic Literature Review
Introduction: The diverse nature of peopleâs care needs requires collaboration between different organisations and sectors. One way of achieving such collaboration is through integrated care service networks. Decision-making is considered an important aspect of network governance and key to achieve further integration of care services. As integrated care scholars only implicitly seem to touch upon the issue of decision-making, we aimed to identify multiple decision-making dilemmas. Theory and Methods: A systematic literature review was conducted of eighteen empirical studies in which decision-making dilemmas in integrated care service networks were inductively identified. To frame and understand these dilemmas, we partly drew on Provan and Kenisâ governance models and their hypothesised decision-making dilemma for service networks. Results: Identified decision-making dilemmas included 1) autonomy versus inter-dependence, 2) diversity versus coherence, and 3) self-interest versus common goals. In line with Provan and Kenisâ hypothesis, we highlight a cross-cutting dilemma of inclusiveness (all viewpoints are considered hence widely supported decisions) vs. efficiency (reaching timely decisions). Discussion and conclusion: We believe that network- and âsystemicâ stakeholders both need to reflect upon and learn from decision-making dilemmas to work towards widely supported and adequate decisions. This is important for achieving aligned and holistic care services that many people desire
The development of integrated diabetes care in the Netherlands: a multiplayer self-assessment analysis
Optimising integrated stroke care in regional networks:A nationwide self-assessment study in 2012, 2015 and 2019
Background: To help enhance the quality of integrated stroke care delivery, regional stroke services networks in the Netherlands participated in a self-assessment study in 2012, 2015 and 2019. Methods: Coordinators of the regional stroke services networks filled out an online self-assessment questionnaire in 2012, 2015 and 2019. The questionnaire, which was based on the Development Model for Integrated Care, consisted of 97 questions in nine clusters (themes). Cluster scores were calculated as proportions of the activities implemented. Associations between clusters and features of stroke services were assessed by regression analysis. Results: The response rate varied from 93.1% (2012) to 85.5% (2019). Over the years, the regional stroke services networks increased in âsizeâ: the median number of organisations involved and the volume of patients per network increased (7 and 499 in 2019, compared to 5 and 364 in 2012). At the same time, fewer coordinators were appointed for more than 1 day a week in 2019 (35.1%) compared to 2012 (45.9%). Between 2012 and 2019, there were statistically significantly more elements implemented in four out of nine clusters: âTransparent entrepreneurshipâ (MD = 18.0% F(1) = 10.693, p = 0.001), âRoles and tasksâ (MD = 14.0% F(1) = 9.255, p = 0.003), âPatient-centerednessâ (MD = 12.9% F(1) = 9.255, p = 0.003), and âCommitmentâ (MD = 11.2%, F(1) = 4.982, p = 0.028). A statistically significant positive correlation was found for all clusters between implementation of activities and age of the network. In addition, the number of involved organisations is associated with better execution of implemented activities for âTransparent entrepreneurshipâ, âResult-focused learningâ and âQuality of careâ. Conversely, there are small but negative associations between the volume of patients and implementation rates for âInterprofessional teamworkâ and âPatient-centrednessâ. Conclusion: This long-term analyses of stroke service development in the Netherlands, showed that between 2012 and 2019, integrated care activities within the regional stroke networks increased. Experience in collaboration between organisations within a network benefits the uptake of integrated care activities
The role of values in the interorganizational network response to wicked problems
Values are seen as important in both interorganizational networks and wicked problems. However, in both academia and practice the exact implications of these values remain unclear. In this article we examine the role of values in interorganizational networks dealing with wicked problems, by conducting a case study in a pregnancy and childbirth network. Our analysis identified both actor and network values, three value tensions among actors, and a variety of coping strategies to deal with these tensions. The findings indicate that value differentiation in networks should not be only seen as a problem, but also as an important ingredient for the achievement of network goals. Furthermore, our study revealed functional-structural and cognitive-cultural coping strategies to respond to value tensions among actors, applied by both the network administrative organization and the individual actors in the network. Lastly, we elaborate on the position and skill set of the network leader. We leverage these research results to formulate insights and recommendations for network practice
Integrated dementia care in The Netherlands: a multiple case study of case management programmes
The number of dementia patients is growing, and they require a variety of services, making integrated care essential for the ability to continue living in the community. Many healthcare systems in developed countries are exploring new approaches for delivering health and social care. The purpose of this study was to describe and analyse a new approach in extensive case management programmes concerned with long-term dementia care in The Netherlands. The focus is on the characteristics, and success and failure factors of these programmes.A multiple case study was conducted in eight regional dementia care provider networks in The Netherlands. Based on a literature study, a questionnaire was developed for the responsible managers and case managers of the eight case management programmes. During 16 semistructured face-to-face interviews with both respondent groups, a deeper insight into the dementia care programmes was provided. Project documentation for all the cases was studied. The eight programmes were developed independently to improve the quality and continuity of long-term dementia care. The programmes show overlap in terms of their vision, tasks of case managers, case management process and the participating partners in the local dementia care networks. Differences concern the targeted dementia patient groups as well as the background of the case managers and their position in the local dementia care provider network. Factors for success concern the expert knowledge of case managers, investment in a strong provider network and coherent conditions for effective inter-organizational cooperation to deliver integrated care. When explored, caregiver and patient satisfaction was high. Further research into the effects on client outcomes, service use and costs is recommended in order to further analyse the impact of this approach in long-term care. To facilitate implementation, with a focus on joint responsibilities of the involved care providers, policy recommendations are to develop incentives for collaborative financial contracts between insurers and provider
Assessing the maturity of the healthcare system for integrated care: testing measurement properties of the SCIROCCO tool
Abstract Background The Scaling Integrated Care in Context (SCIROCCO) tool has been developed to facilitate knowledge transfer and learning about the implementation and scaling-up of integrated care in European regions. To adequately test the functionality of the tool in assessing the maturity for integrated care within regions, this study evaluated its structural validity, internal consistency and convergent validity. Methods Exploratory factor analysis was used to investigate the structural validity of the 12-items of the SCIROCCO tool. Hereafter, the internal consistency was assessed by calculating Cronbachâs and ordinal alpha. The convergent validity was explored by testing 23 pre-hypothesized relationships between items of the SCIROCCO tool and items of an instrument measuring a similar construct. Results Factor analysis revealed a one-factor structure. Cronbachâs alpha of the overall instrument was 0.92, ordinal alpha was 0.94. Only 30.34% of the hypotheses for testing the convergent validity were met. Conclusion The one-factor structure is considered relevant in representing the structural validity of the SCIROCCO tool. The scale of the SCIROCCO tool shows good internal consistency. The tool (DMIC Quickscan) used to assess the convergent validity might measure a different aspect of integrated care than the SCIROCCO tool. Further research is needed to continue investigating the validity and reliability of the tool
Optimising integrated stroke care in regional networks: A nationwide self-assessment study in 2012, 2015 and 2019
Background: To help enhance the quality of integrated stroke care delivery, regional stroke services networks in the Netherlands participated in a self-assessment study in 2012, 2015 and 2019. Methods: Coordinators of the regional stroke services networks filled out an online self-assessment questionnaire in 2012, 2015 and 2019. The questionnaire, which was based on the Development Model for Integrated Care, consisted of 97 questions in nine clusters (themes). Cluster scores were calculated as proportions of the activities implemented. Associations between clusters and features of stroke services were assessed by regression analysis. Results: The response rate varied from 93.12012) to 85.52019). Over the years, the regional stroke services networks increased in âsizeâ: the median number of organisations involved and the volume of patients per network increased (7 and 499 in 2019, compared to 5 and 364 in 2012). At the same time, fewer coordinators were appointed for more than 1 day a week in 2019 (35.1 compared to 2012 (45.9. Between 2012 and 2019, there were statistically significantly more elements implemented in four out of nine clusters: âTransparent entrepreneurshipâ (MD = 18.01) = 10.693, p = 0.001), âRoles and tasksâ (MD = 14.01) = 9.255, p = 0.003), âPatient-centerednessâ (MD = 12.91) = 9.255, p = 0.003), and âCommitmentâ (MD = 11.2 F(1) = 4.982, p = 0.028). A statistically significant positive correlation was found for all clusters between implementation of activities and age of the network. In addition, the number of involved organisations is associated with better execution of implemented activities for âTransparent entrepreneurshipâ, âResult-focused learningâ and âQuality of careâ. Conversely, there are small but negative associations between the volume of patients and implementation rates for âInterprofessional teamworkâ and âPatient-centrednessâ. Conclusion: This long-term analyses of stroke service development in the Netherlands, showed that between 2012 and 2019, integrated care activities within the regional stroke networks increased. Experience in collaboration between organisations within a network benefits the uptake of integrated care activities