Implementing Buurtzorg-derived models in the home care setting: a Scoping Review

Application of a new municipal management model of Home Care Service in Barcelona: Assessment of workers' labour conditions, health, and well-being

BACKGROUND

In 2018, Barcelona City Council implemented a pilot phase of an organisational change in the municipal home care service (HCS) system. Inspired in the Buurtzorg model, the new model promotes the creation of self-managing teams operating in a restricted community setting.

OBJECTIVE

To assess the pilot phase of the new model, focusing on employees' working and employment conditions as well as on their health and well-being outcomes.

METHODS

Mixed-methods impact evaluation. First, a quantitative evaluation was conducted between October 2018 and October 2020, using a pre-post study design with one pretest and two posttest measurements in an intervention and a comparison group. The intervention group was composed of the members of the work teams implemented in the pilot phase from October 2018 onwards (baseline n = 44). The comparison group consisted of workers from the same districts working under the usual HCS system (baseline n = 72). Next, a qualitative study was conducted in workers from the intervention group in winter 2021-2022 (n = 10).

RESULTS

The pre-post study results yielded positive changes for the intervention group in social support and autonomy, as well as in many of the employment conditions. This group also experienced increases in psychological demands, painful positions, fatigue and psychological distress. Two main themes affecting workers' well-being emerged from the interviews: factors inherent to the self-management model and external factors.

CONCLUSIONS

Health and well-being outcomes seem to depend on the balance between job demands, resources, and ways of channelling conflicts within teams.

How do the existing homecare services correspond with the preferred service ecosystem for senior citizens living at home? A qualitative interview study with multiple stakeholders

Introduction

Often, homecare services are task-focused rather than person-based and fragmented instead of integrated. Consequently, several stakeholders have requested a transformation of the service ecosystem for senior citizens living at home. This transformation may be facilitated by an idealized design approach. However, few studies have applied such an approach. Moreover, previous research did not assess the ways in which the existing homecare services correspond with the preferred service ecosystem for senior citizens living at home. Therefore, the purpose of this study is to gain an understanding of how the existing homecare services correspond with the preferred service ecosystem for senior citizens living at home, according to different stakeholders.

Methods

Four stakeholder groups (n = 57) from a Norwegian municipality participated in an interview study (2019-2020): senior citizens, carers, healthcare professionals and managers. A directed qualitative content analysis was applied, guided by a four-category framework for the preferred service ecosystem.

Results

All stakeholder groups highlighted several limitations that hindered continuity of the services. There was also agreement on deficiencies in professionals' competence, yet professionals themselves did not focus on this as a significant aspect. Managers emphasised the importance of professionals' reablement competence, which was also considered to be deficient in the current homecare services. Contrary to the other stakeholder groups, most senior citizens seemed satisfied with the practical and social support they received. Together with carers, they also explained why they thought some professionals lack compassion. Their dependency on professionals may limit them in sharing honestly their opinions and preferences during care provision. Involvement of senior citizens in improvement of the current services was limited. Insufficient time and resources, as well as a complex organisation impacted the existing homecare services, and therefore served as barriers to the preferred service ecosystem.

Discussion

In this study there were different degrees of correspondence between the existing homecare services and the preferred service ecosystem according to four stakeholder groups. To develop the preferred service ecosystem, aspects such as predictability, adaptivity, and relationships are key, as well as continuous involvement of senior citizens and other stakeholders. The four-category framework applied in this study served as a tool to assess the existing homecare services.

Interdisciplinary frontline teams in home-based healthcare services-paradoxes between organisational work structures and the trust model: a qualitative study

BACKGROUND

Achieving access to quality healthcare services to ensure healthy lives and promote well-being for all at all ages is one of the United Nation's Sustainable Developments Goals. In view of this goal, sustainable community healthcare services in Norway need to be urgently restructured in light of demographic changes, including an increase in the percentage of older adults in the country. National healthcare policies recommend finding new ways to organise and perform services using new technology, new methods and new solutions. The goal is to ensure greater continuity in the provision of services and softer transitions that enable service users to deal with a smaller number of people. The trust model is one such suggested organisational approach. The goal of the trust model is to involve service users and their next of kin in decisions that concern them while also trusting frontline workers' professional judgement in assessing the need for services and adjusting them to address changes in the health of the users, thus making the services individually tailored and more flexible. This study aims to explore how organisational work structures influence the delivery of interdisciplinary home-based healthcare services.

METHODS

Observations, individual-, and focus groups interviews were conducted within community home-based healthcare services in a large Norwegian city with managers at different levels, nurses, occupational therapists, physiotherapists, purchaser-unit employees and other healthcare workers. Data was analysed thematically.

RESULTS

The results are presented in terms of themes- "Balancing on the margins: Negotiations between the time available, users' needs, unforeseen events and administrative tasks" and "One gathered unit, but with different work structures". The results identify organisational work structures that influence the performance of the trust model with regard to its intention of making flexible and individually tailored services available. However, these structures are different for the members of the interdisciplinary team, thus creating several paradoxes that need to be negotiated while fulfilling their daily responsibilities.

CONCLUSION

This study suggests that it is crucial to pay attention to paradoxes and structures experienced by interdisciplinary frontline workers in home-based healthcare services, since they are unavoidable factors that need to be acknowledged when designing approaches for addressing the changes expected in community healthcare services.

The mediating effect of psychosocial factors in the relationship between self-organizing teams and employee wellbeing: A cross-sectional observational study

BACKGROUND

Several benefits of working in a self-organizing team, such as higher job satisfaction and better engagement to work have been demonstrated in previous studies.

OBJECTIVE

To examine whether those employees working in a self-organizing team have higher job satisfaction and lower turnover intentions compared to those in non-self-organized teams. Further, to test whether psychosocial factors defined by the Job Demand-Control model would function as mediators.

DESIGN

A cross-sectional survey study.

SETTING(S)

Home care and assisted living facilities (with 24-h assistance).

PARTICIPANTS

Licensed practical nurses (N = 377), registered nurses, therapists and managers (N = 183), and other employees (N = 31) in services for older people.

METHODS

A survey for employees working in services for older people and who were either in the self-organized teams or in the non-self-organized teams. Data was analyzed using linear regression and mediation analyses.

RESULTS

Those employees who worked in a self-organizing team were more satisfied with their job and had lower turnover intentions compared to those in a non-self-organizing team (mean [SD] 3.9 [1.0] vs. 3.7 [1.0], p = 0.006 and 2.2 [1.2] vs. 2.5 [1.3], p = 0.006, respectively). Moreover, job demands and job strain partially mediated the effect of self-organizing teamwork on job satisfaction (Average causal mediation effect [95%CI] 0.09 [0.02-0.15] and 0.10 [0.03-0.18], respectively), as well as on turnover intentions (Average causal mediation effect [95%CI] -0.08 [-0.15 to -0.01] and -0.20 [-0.18 to -0.03], respectively).

CONCLUSIONS

In the context of older people care services, working in self-organizing teams may enhance employee wellbeing by lowering job demands and job strain, but not by improving job control. Based on the findings of this study, self-organization seems beneficial, however, it requires real autonomy for the teams and team building.

TWEETABLE ABSTRACT

Self-organizing teamwork increases job satisfaction and decreases turnover intentions via lower job demands and strain in older people care.

Health Professionals' Experience with the First Implementation of the Organizational Health Literacy Self-Assessment Tool for Primary Care (OHL Self-AsseT)-A Qualitative Reflexive Thematic Analysis

Organizational health literacy (OHL) is crucial for public health, in turn health care organizations play vital roles in improving populations' health literacy. Therefore, the aim of this qualitative study was to explore how the organizational health literacy self-assessment tool (OHL Self-AsseT) was implemented, used, and understood by primary care teams from a network of general practices and a Home Care Service Organization in Zurich, Switzerland. Reflexive thematic analysis with a constructivist orientation was used to analyze data from 19 interviews pre- and post-OHL Self-AsseT use. Normalization Process Theory supported structuring of inductively developed themes. Findings show that the participants experienced working with the OHL Self-AsseT meaningful, as it helped with "Addressing OHL construction sites" so that they could "build momentum for change". The experience of "Succeeding together in construction" led to a "feeling of team-efficacy during change". Practical use of the tool and/or discussions about OHL led to a growing conceptual understanding, which was described as "Using a construction plan-making sense of ongoing OHL activities". To conclude, the OHL Self-AsseT encouraged teams to initiate change, led to greater team-efficacy and supported the construction of OHL. Improved implementation strategies will support this intervention's scale-up as a base for effectiveness testing.

Uncovering the Complexity of Care Networks – Towards a Taxonomy of Collaboration Complexity in Homecare

In homecare, networks are formed by professional, semiprofessional, and informal actors, who collaborate to care for people in need. Modern information and communication technology (ICT) might play an important role to enhance cooperation in homecare networks. Through infrastructuring work, the authors seek to build a comprehensive understanding of the types of collaboration complexity in homecare networks to determine if, when and which technologies are most suitable. This paper examines how homecare networks can be classified according to collaboration complexity. A four-stage research design was followed to develop a taxonomy for homecare collaboration. The taxonomy was applied to 21 care networks, and five types of homecare networks were identified. The taxonomy considers network, tasks, and communication particularities across 13 dimensions, each of which includes three characteristics. Three clusters were identified as more likely than the others to benefit from increased technology use. The taxonomy and archetypes highlight which homecare network types could benefit from increased technology use. Additionally, the taxonomy allows for an iterative re-evaluation of networks to initiate measures for improvement.

An integrated care systems model approach for speech and language therapy head and neck cancer services in England: service development and re-design in Cheshire and Merseyside

PURPOSE OF REVIEW

The incidence of head and neck cancer (HNC) is increasing globally and changes in treatment mean that patients are living longer with the condition. It is recognised that while there have been improvements at the diagnostic phase of the pathway, follow-up and on-going care can be fragmented and inequitable. Integrated care models (ICMs) are acknowledged as beneficial. The National Health Service in England is moving to a model whereby services are being re-organised to integrated care systems. This paper reviews the literature and discusses potential models of care to enhance speech and language therapy (SLT) provision for patients with HNC in line with the emerging ICS.

RECENT FINDINGS

The COVID-19 pandemic has provided an opportunity to review service provision and SLT teams quickly adapted to offering remote support. Discussions are currently on-going to explore the potential for patient initiated follow-up via the PETNECK 2 trial and the Buurtzorg 'neighbourhood model' holds promise.

SUMMARY

ICMs put the patient at the centre of care and have reported benefits for experience of care and clinical outcomes. Navigating organisational structures is complex. The Buurtzorg model provides a practical and theoretical framework to support organisational change.

Opportunities and challenges for home care services in implementing the Buurtzorg model in Switzerland: results of an exploratory case study / Chancen und Herausforderungen für häusliche Pflegedienste bei der Umsetzung des Buurtzorg-Modells in der Schweiz: Ergebnisse einer explorativen Fallstudie

Hintergrund

Das starke Leistungswachstum kombiniert mit dem Fachkräftemangel in der häuslichen Pflege verlangt nach einer anpassungsfähigen Betriebsorganisation. Das niederländische Buurtzorg-Modell orientiert sich am Ansatz der Holokratie und verspricht eine Reorganisation der Pflege im Privathaushalt, welche sich positiv auf die Zufriedenheit der Mitarbeitenden und die Personzentrierung auswirkt. Das Buurtzorg-Modell stößt auch in der Schweiz auf reges Interesse.

Ziel

Ziel war es, Informationen darüber zu erhalten, wie die unterschiedlichen Mitarbeitenden-Gruppen mit den Veränderungen umgehen, welche durch die Umstrukturierung hin zum Buurtzorg-Modell ausgelöst wurden.

Methode

Der Reorganisationsprozess in 3 häuslichen Pflegediensten in der Deutschschweiz wurde multimethodisch untersucht und nachgezeichnet (11 Interviews mit Leitungspersonen und Coaches, 7 Fokusgruppengespräche, 12 problemzentrierte Interviews mit Mitarbeitenden, 5 teilnehmende Beobachtungen bei Teamsitzungen). Um Veränderungen im Prozess zu erfassen, erfolgte die Datenerhebung zu zwei Zeitpunkten mit neun Monaten Abstand. Die Analyse erfolgte nach der strukturierten Inhaltsanalyse nach Mayring.

Ergebnisse

Für die Adaption des Buurtzorg-Modells waren Anpassungsleistungen bei Rollen und Aufgaben sowohl auf individueller als auch Team- und Organisationsebene erforderlich. Dies ging einher mit einer von Berufsabschlüssen möglichst losgelösten Arbeitsteilung, was zu neuen Zusammenarbeitsformen führte. Dies eröffnete Chancen aber auch Spannungsfelder, die durch die neue Rolle der Coaches unterstützend begleitet wurden.

Schlussfolgerungen

Den Wandel in gedrängter Zeit zu leisten, erweist sich als Kraftakt. Für die betriebliche Praxis wichtig sind genügend und geeignete Reflexionsmöglichkeiten und Austauschgefäße, um die diskutierten Spannungsfelder auszuloten und aufzufangen. Außerdem braucht es den Auf- und Ausbau einer breit verankerten betrieblichen Lernkultur, damit sämtliche Mitarbeitende begleitet in die neue Arbeitsweise hineinwachsen können.