Acceptability of delivering an adapted Buurtzorg model in the Scottish care context

Community health services in European literature: A systematic review of their features, outcomes, and nursing contribution to care

BACKGROUND

To meet the population's needs, community care should be customized and continuous, adequately equipped, and monitored.

INTRODUCTION

Considering their fragmented and heterogeneous nature, a summary of community healthcare services described in European literature is needed. The aim of this study was to summarize their organizational models, outcomes, nursing contribution to care, and nursing-related determinants of outcomes.

METHODS

A systematic review was performed by searching PubMed, CINAHL, Scopus, and Embase in October 2022 and October 2023 (for updated results). Quantitative studies investigating the effects of community care, including nursing contribution, on patient outcomes were included and summarized. Reporting followed the PRISMA checklist. The review protocol was registered on PROSPERO (CRD42022383856).

RESULTS

Twenty-three studies describing six types of community care services were included, which are heterogeneous in terms of target population, country, interventions, organizational characteristics, and investigated outcomes. Heterogeneous services' effects were observed for access to emergency services, satisfaction, and compliance with treatment. Services revealed a potential to reduce rehospitalizations of people with long-term conditions, frail or older persons, children, and heart failure patients. Models are mainly multidisciplinary and, although staffing and workload may also have an impact on provided care, this was not enough investigated.

DISCUSSION

Community health services described in European literature in the last decade are in line with population needs and suggest different suitable models and settings according to different care needs. Community care should be strengthened in health systems, although the influence of staffing, workload, and work environment on nursing care should be investigated by developing new management models.

CONCLUSIONS AND IMPLICATIONS FOR HEALTH POLICY

Community care models are heterogeneous across Europe, and the optimum organizational structure is not clear yet. Future policies should consider the impact of community care on both health and economic outcomes and enhance nursing contributions to care.

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.

Integrated Community Care Delivered by Public Health-Care and Social-Care Systems: Results from a Realist Synthesis

Introduction

Integrated community care (ICC) is defined as an interweaving of health-care and social-care interventions deployed in spatial and relational proximity using an interdisciplinary and cross-sectoral approach. Consideration of territory scale and time scale are at the center of ICC practices. Its deployment in public health and social care networks (HSCN) can be complex due to their broad mandate, the complexity of their management, and accountability. Therefore, we aimed to describe ICC delivered by public HSCN to determine how, why, for whom, and in what circumstances ICC works and produces outcomes.

Methods

A realist synthesis was conducted consisting of five steps consistent with realist synthesis standards (RAMESES projects) to produce configurations of Context - Mechanism - Outcomes (CMOc) and development of a middle-range explanatory theory of why and how the identified outcomes may have occurred.

Results

In total, 26 studies were selected and used, as evidence, to support-either partially or fully-the production of CMOc based on the initial program theory. Nine unique CMO configurations were identified based on the data analyses and team discussion. ICC middle-range theory is informed by the CMO configurations identified.

Discussion

This realist synthesis allowed us to identify the central mechanisms of ICC delivered by public HSCN and to produce a middle range theory. ICC is based on a specific philosophy and deployed by a professional agency oriented toward a community agency within a local system of interdisciplinary and cross-sectoral action.

Conclusion

Our middle-range theory will provide a solid analytical framework as a foundation for ICC implementation and future research.

Exploring the implementation and evaluation of a distributed leadership model within a Scottish, integrated health and care context

Background

Health and care systems are facing unprecedented challenges, exacerbated by wicked issues that have no single solution and are complex to solve. It has recently been suggested that how such systems are structured (ie, in hierarchies) may not be the most effective approach to tackling these issues. Increasing calls have been made for senior leaders within these systems to adopt structures that emphasise leadership as a distributed endeavour as an approach to foster greater collaboration and enhance innovation. Here, the implementation and evaluation of a distributed leadership model within a Scottish, integrated health and care context is described.

Methods

Aberdeen City Health & Social Care Partnership’s leadership team (N=17 as of time in 2021) have been operating in a flat, distributed leadership model since 2019. The model is characterised by a 4P approach (professional; performance; personal development and peer support). The evaluation approach was a national healthcare survey administered at three time points and a further evaluation questionnaire specifically assessing constructs associated with high-performing teams.

Results

Results indicated that staff satisfaction increased 3 years into the flat structure (mean score=7.7/10) compared with the traditional, hierarchal structure (mean score=5.18/10). Respondents were agreeable that the model had increased autonomy (67% agreeableness); collaboration (81% agreeableness) and creativity (67% agreeableness)

Conclusions

Overall, results suggest that a flat, distributed leadership model is preferable to a traditional, hierarchal leadership model within this context. Future work should aim to explore the impact that this model has on the effectiveness of planning and delivering integrated care services.

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

Background

Buurtzorg is a pioneering healthcare organization founded in the Netherlands. Buurtzorg has established independent, self-managing teams of nurses and promises high-quality home care at a lower cost through person-centered care, continuity of care, building trusting relationships, and networks in the neighborhood. Traditional home care services are increasingly reorganized according to the Buurtzorg-principles.

Objectives

This review aims to describe the experiences gathered during the implementation of the Buurtzorg-derived model outside the Netherlands. It further outlines their potential effects.

Design

Scoping Review.

Methods

Several electronic databases were searched for relevant articles, supplemented by hand-searching and internet searches for gray literature. Various publication types that described the implementation of the Buurtzorg model or its outcomes in countries other than the Netherlands were included. The data were analyzed using qualitative content analysis. Two authors coded the data in several cycles and created categories and subcategories.

Results

The review identified 25 publications reporting the experiences or outcomes of Buurtzorg-derived models outside the Netherlands. Upon implementing elements of Buurtzorg, the home care organizations adopted a person-centered care approach, with improved communication with patients and family caregivers, and could establish new networks with other services. The main challenges were related to the self-managed working culture, the organizational framework, or national healthcare policies, which hindered the implementation process.

Conclusions

The implementation of Buurtzorg-derived models is complex, challenging, and requires adaptations on several levels: upskilling of networking and staffing competencies in teams, leadership and IT requirements in the organization, and policy changes in the healthcare system. Individualized approaches and solid conceptual preparation are required for implementation.

Tweetable abstract

Experiences with the implementation of Buurtzorg in home care services outside the Netherlands. A scoping review @HegeduesAnna.

District nursing using neighbourhood care principles in practice: reflecting on our experience

There is much interest in the UK, and elsewhere, in the Dutch Buurtzorg model of providing district nursing, and there a number of published, external evaluations of pilot projects. We are nurses who worked in one such pilot that used an adapted Buurtzorg model called neighbourhood nursing using neighbourhood care principles. This article reflects on our experience and describes how we organised ourselves and, our experiences of working in such ways as well as the challenges. This article also offers advice for others who are considering introducing such models.

The implementation and outcomes of self-managing teams in elderly care: A scoping review

AIM

We aim to map the existing evidence and gaps in research on the implementation and outcomes of self-managing elderly care teams.

BACKGROUND

Due to increasing demand for elderly nursing care and an ageing workforce, recruiting and retaining community nurses have become challenging. Implementing self-managing teams may be a solution to address this problem.

EVALUATION

This scoping review included 27 studies, varying from narrative reviews to a quantitative cross-sectional study. The studies' primary focus on self-managing teams was essential for eligibility.

KEY ISSUES

Nurses' job satisfaction was high in self-managing teams due to improved relationships with patients and increased autonomy. Continuity of care and patient acceptability were high. Transformation of managers to coaches in a team with a flat hierarchy is needed to empower nurses with responsibility for their own work. Trust and teamwork should be assisted by suitable ICT support systems.

CONCLUSIONS

International interest in self-managing teams is large, but quantitative research is limited and guidelines for implementation are needed. Recommendations for potential successful implementation were made.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse autonomy and job satisfaction can increase by implementing self-managing teams. This requires a change in management styles, from managing to coaching nurses.

Implementation of an innovative model of community nursing for older adults based on Buurtzorg principles: a scoping review protocol

OBJECTIVE

The objective of this review is to map the international evidence on the implementation of the Buurtzorg model of community nursing practice for the care of older adults. We will describe where and how it has been used, and the challenges and facilitators of implementing this model of care.

INTRODUCTION

The challenges of aging have mobilized health systems around the world to replace the current facility- and disease-centered care model with integrated patient-centered care models. The Buurtzorg model provides autonomy to nurses, who, in turn, empower patients in need-based and self-reliant care.

INCLUSION CRITERIA

We will consider both published and unpublished studies and reports exploring the process of implementing the Buurtzorg community nursing model for the care of older adults (65 years and older) internationally, in all settings. Concepts of interest will include where the model has been used, how the model has been implemented, and what challenges and facilitators were reported.

METHODS

We will implement a three-step search strategy to locate both published and unpublished primary studies, theses, dissertations, book chapters, and text and opinion reports using the following databases: MEDLINE, LILACS, Cochrane CENTRAL, CINAHL, Web of Science, Google Scholar, Embase, Scopus, ProQuest Dissertations and Theses Global, and the official Buurtzorg website. We will present the search strategy in a PRISMA flow diagram. Data will be extracted using Excel spreadsheets and then analyzed narratively. Extracted data will be quantitatively pooled in tables using descriptive statistics to synthesize the characteristics of the reports and sample, followed by a qualitative summary of how the Buurtzorg model has been used, and the challenges and facilitators of implementing this care model.

Buurtzorg Nederland, a proposal for nurse-led home care

Buurtzorg Nederland is a Dutch healthcare organization in which nursing teams provide home care in all the skills that affect their profession. This article raises some questions regarding more internal aspects of the organization based on three dimensions. The first, the organizational dimension, in which the teams are structured based on 8 roles, without hierarchies and supported by the coaching system. The second, the nursing dimension, in which it is highlighted that nurses deal with all the competences that affect their profession, from basic care to more complex care, with the aim of defragmenting care. And the third, the economic dimension, in which it stands out that the sustainability of the organization is in being a system without managers, of small teams that work in small geographic areas, with a computer system that supports all organizational matters, healthcare and financial. The main characteristics of Buurtzorg Nederland are the self-management of the teams and the defragmented care that both the nurse and the patient satisfy. However, this defragmentation has been achieved in terms of patient care, with the same team attending to all basic and complex care needs at home, but at other levels of care it has not been achieved, and the patient must visit other providers, therefore, health care at other levels continues to be fragmented.

Staff views of a hospital at home model implemented in a Scottish care setting

Purpose

Demographic and financial challenges mean prioritising a shift in healthcare provision from acute to community settings. One well-evidenced model encapsulating this is 'hospital at home', however limited research has examined staffs' views on its implementation, which may inform service development and increase job satisfaction. The aim within was to explore the staff perspective of implementing a 'hospital at home' model in a Scottish care setting which can inform service provision and ultimately increase job satisfaction.

Methods

The 'Acute Care @ Home' (AC@H) service had a multi-disciplinary team. Referrals were predominantly received from a geriatric hospital ward. Inclusion criteria were older adults with geriatric syndromes and who required care input for a duration between one to seven days. In-depth staff interviews (N = 13) were conducted and analysed thematically to understand barriers and facilitators to implementation. These were supplemented with questionnaires assessing constructs of interest including training, communication and overall satisfaction.

Results

Several themes urged from our study: inter-team and intra-team collaboration, service development and operation, and scaling considerations. High job satisfaction was reported (mean score 73%), particularly due to a perceived non-hierarchical team structure and inclusive management style. Staff attributed positive outcomes through better identifying patients' needs at home compared to in hospital. Continuity of care facilitated rapport building. Recruitment challenges restricted the acuity and volume of patients the team were able to care for.

Conclusions

This qualitative methodology could be useful for future implementation of intermediate care resources for the future health and care system building. Patient assessments at home, as opposed to in hospital, in conjunction with care continuity by staff, may mitigate against hospital risks and better facilitate reablement. Where recruitment challenges are present, agile models of care delivery should be considered.

Buurtzorg Nederland, a proposal for nurse-led home care

Buurtzorg Nederland is a Dutch healthcare organization in which nursing teams provide home care in all the skills that affect their profession. This article raises some questions regarding more internal aspects of the organization based on 3dimensions. The first, the organizational dimension, in which the teams are structured based on 8 roles, without hierarchies and supported by the coaching system. The second, the nursing dimension, in which it is highlighted that nurses deal with all the competences that affect their profession, from basic care to more complex care, with the aim of defragmenting care. And the third, the economic dimension, in which it stands out that the sustainability of the organization is in being a system without managers, of small teams that work in small geographic areas, with a computer system that supports all organizational matters, healthcare and financial. The main characteristics of Buurtzorg Nederland are the self-management of the teams and the defragmented care that both the nurse and the patient satisfy. However, this defragmentation has been achieved in terms of patient care, with the same team attending to all basic and complex care needs at home, but at other levels of care it has not been achieved, and the patient must visit other providers, therefore, health care at other levels continues to be fragmented.