Coordination as a critical element of managed care

Conceptual framework for acute community health care services - Illustrated by assessing the development of services in Denmark

Acute community health care services can support continuity of care by acting as a bridge between the primary and secondary health care sectors in the early detection of acute disease and provision of treatment and care. Although acute community health care services are a political priority in many countries, the literature on their organization and effect is limited. We present a conceptual framework for describing acute community health care services that can be used to support the policies and guidelines for such services. For illustrative purposes, we apply the framework to the Danish acute community health care services using implementation data from 2020 and identify gaps and opportunities for learning. The framework identifies two key pairs of dimensions: (1) capacity & capability, and (2) coordination & collaboration. These dimensions, together with the governance structure and quality assurance initiatives, are of key importance to the effect of acute community health care services. While all Danish municipalities have implemented acute community health care services, application of the framework indicates considerable variation in their approaches. The conceptual framework provides a systematic approach supporting the development, implementation, evaluation, and monitoring of acute community health care services and can assist policymakers at both national and local levels in this work.

What is care coordination?

Introduction

Care coordination is a high-priority area for improvement across healthcare systems, but no consensus definition of care coordination exists.

Methods

This article reviews published definitions of the term “care coordination,” identifies common themes among them, and presents a broad working definition of care coordination.

Results

The review identified 57 unique definitions of care coordination, ranging widely in the scope of participants, settings, and care processes included. Five major themes emerged from the definitions: care coordination involves numerous participants, is necessitated by interdependence among participants and activities, requires knowledge of others’ roles and resources, relies on information exchange, and aims to facilitate appropriate healthcare delivery. Only one definition identified included all five themes, and no one theme was found in a clear majority of definitions. The synthesized themes were incorporated into a broad working definition of care coordination, which has resulted in numerous uses (e.g. guide for systematic review of interventions, development of a measures repository, reference for this journal’s recast focus on the subject).

Discussion

Some ambiguity remains about the definition of care coordination, but the breadth of definitions in use underscores its widespread recognition as important for high-quality care. Even as understanding of care coordination continues to evolve, broad and flexible definitions can help guide the iterative process of developing conceptual models, testing them empirically, refining models, generating evidence about what works best, and ultimately improving the quality of care.

Hospital quality improvement in context: a multilevel analysis of staff job evaluations

OBJECTIVE

To investigate how much of the variance in data on nurse evaluation of different aspects of hospital work can be attributed to individual, ward, department and hospital levels, and to discuss the implication of the findings on quality improvement strategies.

DESIGN AND METHOD

National survey data of work experiences were collected from hospital nurses working at 124 hospital wards in 36 departments in 15 hospitals across Norway during the autumn of 1998. The multilevel structure of the variation of nine indices of job satisfaction was explored by fitting four-level random intercept models (nurse, ward, department and hospital).

RESULTS

A total of 2606 nurses (66%) responded. The indices showed varying clustering to organizational units. Intraclass correlations (ICCs) varied from 0.05 to 0.38, representing considerable higher level variation. The ward level was the dominating level for the clustering of nurses' job aspect evaluations.

CONCLUSION

Multilevel modelling of staff work experiences may identify which improvement goals can be addressed at which organizational level. Improvement efforts should be directed specifically towards each aspect of work and at its most relevant organizational level. Strategies aimed at the micro-organizational level (ward management) rather than the individual level or the macro level (hospital top management) might prove worthwhile.

Realigning the Communication Paradigm in Nursing Case Management

Communication underlies all of case management (CM), and better comprehension of the processes of communication within the context of the CM role may facilitate positive patient and organizational outcomes, and assist providers and policy makers in designing effective CM systems. Thus, the purpose of this qualitative, pilot project was to explore dimensions of communication of the nurse case manager role within a hospital setting. The results describe a “hub and spoke” model of communications and suggest the utility of this familiar model for understanding the communication dynamics for those who work as nursing case managers in hospital settings. Findings suggest that nurse case managers are at various times both advocates and mediators—communications roles that may encompass somewhat contradictory demands and perspectives.

Effect of hospital conversion on organizational decision making and service coordination

This study looks into the "black box" of hospital ownership conversion in a "natural experiment." We posed two competing theories about how conversion might influence management practices. Results support complexity theory and not threat-rigidity theory. As predicted from complexity theory, MDs and RNs had greater levels of participation and influence over final decision choices in converted hospitals than in nonconverted hospitals.