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de Weger E, Drewes H, Luijkx K, Baan C. Tracking the Development of Community Engagement Over Time: Realist Qualitative Study. J Particip Med 2024; 16:e47500. [PMID: 38748458 PMCID: PMC11137424 DOI: 10.2196/47500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 10/30/2023] [Accepted: 11/12/2023] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND A growing interest in engaging communities in the development of health care services and communities has not automatically led to progress or consensus as to how to engage communities successfully, despite the evidence base showing how to leverage enablers and alleviate barriers. OBJECTIVE To bridge the gap between the evidence base and which community engagement (CE) approaches have actually been applied in practice over time, this study aims to investigate how CE approaches have changed over the past 4 years in 6 different regions in the Netherlands and citizens' and professionals' experiences underlying these changes. METHODS For the last stage of a multiple case study following the development of CE approaches in 6 different regions in the Netherlands, a realist qualitative case study was conducted. To investigate how CE approaches had changed over the past 4 years, data from the entire 4 years of the study were used, including documents, interview transcripts, and observations. To examine citizens' and professionals' experiences underlying these changes, new interviews were conducted. The latest interview results were discussed with a panel to ensure the results had face validity. RESULTS The regions had implemented different types of CE approaches over the past 4 years and were adapting these approaches over time. Many of the (remaining) approaches may be operating on a smaller scale. The study identified the following overarching themes along which CE had been adapted: fewer region-wide approaches and more community-focused approaches, more focus on building relationships with (already engaged) citizens and community-led initiatives, and more focus on practical and tangible health promotion and social cohesion activities and less focus on complex "abstract" programs. The study identified a further 4 overarching themes highlighting citizens' and professionals' experiences underlying these changes in the CE approaches: a lack of engagement environment, need for facilitative leadership from organizations, need for a clear and shared vision underscoring the importance of CE, and misalignment between citizens' and professionals' perspectives and motivations for CE. All participants had experienced the engagement environment as insufficient. To support CE, professionals experienced the need to develop and receive more facilitative leadership and to develop approaches better equipped to involve citizens in the decision-making process. Citizens experienced the need to better align citizens' and professionals' motivations and aims for CE approaches and to receive longer-term financial support for their community-led initiatives. CONCLUSIONS This study suggests that CE has not yet been embedded within organizational cultures. This has arguably meant that the (remaining) CE approaches are operating on a smaller scale. To enable the further development of CE approaches, an investment in the engagement environment and a shared vision is required. Only then could CE within the regions move beyond the more seemingly smaller-scale CE approaches.
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Affiliation(s)
- Esther de Weger
- Department of Tranzo, Tilburg School of Social and Behavioural Sciences, Tilburg University, Tilburg, Netherlands
- Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Katrien Luijkx
- Department of Tranzo, Tilburg School of Social and Behavioural Sciences, Tilburg University, Tilburg, Netherlands
| | - Caroline Baan
- Department of Tranzo, Tilburg School of Social and Behavioural Sciences, Tilburg University, Tilburg, Netherlands
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Conquer S, Iles R, Windle K, Heathershaw R, Ski CF. Transforming Integrated Care Through Co-production: A Systematic Review Using Meta-ethnography. Int J Integr Care 2024; 24:17. [PMID: 38463747 PMCID: PMC10921964 DOI: 10.5334/ijic.7603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 02/29/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction There is a requirement for health and care systems and services to work on an equitable basis with people who use and provide integrated care. In response, co-production has become essential in the design and transformation of services. Globally, an array of approaches have been implemented to achieve this. This unique review explores multi-context and multi-method examples of co-production in integrated care using an exceptional combination of methods. Aim To review and synthesise evidence that examines how co-production with service users, unpaid carers and members of staff can affect the design and transformation of integrated care services. Methods Systematic review using meta-ethnography with input from a patient and public involvement (PPI) co-production advisory group. Meta-ethnography can generate theories by interpreting patterns between studies set in different contexts. Nine academic and four grey literature databases were searched for publications between 2012-2022. Data were extracted, analysed, translated and interpreted using the seven phases of meta-ethnography and PPI. Findings A total of 2,097 studies were identified. 10 met the inclusion criteria. Studies demonstrated a variety of integrated care provisions for diverse populations. Co-production was most successful through person-centred design, innovative planning, and collaboration. Key impacts on service transformation were structural changes, accessibility, and acceptability of service delivery. The methods applied organically drew out new interpretations, namely a novel cyclic framework for application within integrated care. Conclusion Effective co-production requires a process with a well-defined focus. Implementing co-delivery, with peer support, facilitates service user involvement to be embedded at a higher level on the 'ladder of co-production'. An additional step on the ladder is proposed; a cyclic co-delivery framework. This innovative and operational development has potential to enable better-sustained person-centred integrated care services.
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McKeown A. Ethical challenges and principles in integrated care. Br Med Bull 2023; 146:4-18. [PMID: 37100423 PMCID: PMC10286793 DOI: 10.1093/bmb/ldac030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/18/2022] [Accepted: 10/21/2022] [Indexed: 04/28/2023]
Abstract
INTRODUCTION Integrated care is an established approach to delivery in parts of the healthcare infrastructure, and an ideal which, it is claimed, should be realized system-wide. Its ethical weight derives from its defence of a view about how healthcare ought to operate. Although the goal of integration is laudable, it is ethically and practically complex, involving trade-offs. SOURCES OF DATA Considerable evidence attests to widespread enthusiasm for integration, given the need to prevent harm and extend the reach of scarce resources. Equally, evidence increasingly highlights the obstacles to successfully translating this ideal into practice. AREAS OF AGREEMENT The principle that healthcare should be seamless, ensuring that patients do not come to harm through gaps in care enjoys broad agreement. There is a similar consensus that placing the patient's perspective at the centre of decision-making is vital, since this enables identification of these gaps. AREAS OF CONTROVERSY Integrating care by making it seamless entails blurring boundaries of care domains. This risks undermining the locus of responsibility for care decisions via confusion about who has ownership of specialist knowledge where domains overlap. There is a lack of consensus about how successful integration should be measured. GROWING POINTS More research into the relative cost-effectiveness of upstream public health investment in preventing chronic ill-health caused by modifiable lifestyle factors vs integrating care for people already ill; further research into ethical implications of integration in practice, which can be obscured by the simplicity of the fundamental normative principle guiding integration in theory.
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Affiliation(s)
- Alex McKeown
- Department of Psychiatry, Wellcome Centre for Ethics and Humanities, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, Oxfordshire, OX3 7JX, UK
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Reinhoudt‐den Boer L, van Wijngaarden J, Huijsman R. How do clients with multiple problems and (in)formal caretakers coproduce integrated care and support? A longitudinal study on integrated care trajectories of clients with multiple problems. Health Expect 2022; 26:268-281. [PMID: 36523166 PMCID: PMC9854308 DOI: 10.1111/hex.13653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 10/07/2022] [Accepted: 10/23/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Integrated care can create several advantages, such as better quality of care and better outcomes. These advantages apply especially to clients with multiple problems (CWMPs) who have multiple, interconnected needs that span health and social issues and require different health care (e.g., mental health care or addiction care), social care (e.g., social benefits) and welfare services at the same time. Integrated care is most often studied as a phenomenon taking place at the system, organizational, professional and clinical levels. Therefore, in many studies, clients seem to be implicitly conceptualized as passive recipients of care. Less research has been conducted on how clients and (in)formal caretakers coproduce integrated care. METHODS We performed a longitudinal study to investigate how CWPMs and (in)formal caretakers coproduce integrated care. Data were collected among CWMPs and their (in)formal caretakers in Rotterdam, the Netherlands. CWMPs' care trajectories were followed for 1-1.5 years. CWMPs were interviewed three times at an interval of 6 months (T0, T1, T2). Informal caretakers were interviewed three times (T0, T1, T2), and formal caretakers of 16 clients were interviewed twice (T1, T2). Data in the municipal record systems about participating CWMPs were also included. RESULTS Our study shows that the CWMPs' multidimensional needs, which should function as the organizing principle of integrated care, are rarely completely assessed at the start (first 6 weeks) of CWMPs' care trajectories. Important drivers behind this shortcoming are the urgent problems CWMPs enter the support trajectory with, their lack of trust in 'the government' and the complexity of their situations. We subsequently found two distinct types of cases. The highest level of integrated care is achieved when formal caretakers initiate an iterative process in which the CWMP's multidimensional needs are constantly further mapped out and interventions are attuned to this new information. CONCLUSIONS Our study indicates that integrated care is the joint product of formal caretakers and CWMPs. Integrated care however does not come naturally when CWMPs are 'put at the center'. Professionals need to play a leading role in engaging CWMPs to coproduce integrated care. PATIENT CONTRIBUTION CWMPs and their (in)formal caretakers participated in this study via interviews and contributed with their experiences of the process.
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Affiliation(s)
- Lieke Reinhoudt‐den Boer
- Department of Health Services Management & OrganisationErasmus School of Health Policy and ManagementRotterdamThe Netherlands
| | - Jeroen van Wijngaarden
- Department of Health Services Management & OrganisationErasmus School of Health Policy and ManagementRotterdamThe Netherlands
| | - Robbert Huijsman
- Department of Health Services Management & OrganisationErasmus School of Health Policy and ManagementRotterdamThe Netherlands
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Engaging citizens in local health policymaking. A realist explorative case-study. PLoS One 2022; 17:e0265404. [PMID: 35324975 PMCID: PMC8946671 DOI: 10.1371/journal.pone.0265404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 03/02/2022] [Indexed: 11/19/2022] Open
Abstract
Background Municipalities have been trying to involve citizens as citizen participation is thought to improve municipalities’ accountability, the quality of services, and to align policies and services to communities’ needs. This study examined citizens’ participation preferences in policymaking by investigating their health policy priorities, expectations of involvement, and required support. Methods For this case-study the realist evaluation approach was applied to focus groups with citizens and to a workshop with a local panel consisting of professionals, citizens and citizen representatives. Results This study showed that citizens want to be involved in (health) policymaking with the aim of improving their communities’ quality of life and living environment and prioritised local services and amenities (e.g. suitable housing, public transport, health and care services). Instead, professionals’ priorities were focussed on singular public health issues related to prevention and lifestyle factors. The results also show that citizens felt responsible for driving citizen participation and representing community needs to the municipality, but needed the municipality to improve their communication and accessibility in order to do so successfully. Furthermore, the professionals on the panel indicated that they needed training on how to reach out to citizens. Such training should highlight how to better align their language to citizens’ lived experiences. They also wanted their organisations to provide more space, flexibility and resources to build relationships with citizens in order to provide improved communication and accessibility to citizens. Conclusion The difference in priorities between citizens and professionals highlights the importance of involving citizens in policymaking. Moreover, citizens’ involvement can act as a lever for change to bring a wider range of services and policy sectors together and has the potential to better align policies to citizens’ lived experiences and hopefully increase the democratic legitimacy of policymaking. However, to fulfil such potential municipalities will need to invest in improving their accessibility and communication with communities.
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Bernardino E, Sousa SMD, Nascimento JDD, Lacerda MR, Torres DG, Gonçalves LS. Cuidados de transição: análise do conceito na gestão da alta hospitalar. ESCOLA ANNA NERY 2022. [DOI: 10.1590/2177-9465-ean-2020-0435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo analisar o conceito Cuidados de Transição no contexto da gestão da alta hospitalar. Método reflexão analítica utilizando-se a análise conceitual de Walker e Avant: seleção do conceito; definição do objetivo, identificação do uso do conceito (busca na literatura e dicionários entre setembro-dezembro/2019 nas bases de dados: PubMed, Biblioteca Virtual em Saúde e SCOPUS. Consideraram-se 77 artigos que contemplaram conceito e outros termos que corroboraram o estudo; para fins metodológicos, 12 estudos possibilitaram a análise); definição dos atributos; descrição de caso modelo; descrição de casos adicionais; definição de antecedentes e consequentes; definição de indicadores empíricos. Resultados os antecedentes cuidados fragmentados e reinternação são comuns ao conceito. Identificaram-se atributos cuidado integrado, colaboração profissional, coordenação, planejamento da alta, comunicação, integração profissional e gerenciamento de casos. Conclusão e implicações para a prática foi oportuno analisar o conceito em conjunto com termos relacionados ao contexto da alta hospitalar. Cuidados de Transição são práticas coordenadas e eficazes para a Continuidade dos Cuidados na transferência do usuário na alta hospitalar; nesse contexto, as Enfermeiras de Ligação são potenciais protagonistas para estar à frente nesse processo de Integração. As especificidades do conceito poderão favorecer a sua compreensão e a construção de conhecimentos que repercutam no cuidado coordenado e contínuo.
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Girardi G, Farnese ML, Scarponi F, De Tanti A, Bartolo M, Intiso D, Formisano R, Antonucci G. User-centered practices in the eyes of informal caregivers of in-patients with severe acquired brain injury: needs, caring experience, and satisfaction. Brain Inj 2021; 35:1402-1412. [PMID: 34487469 DOI: 10.1080/02699052.2021.1972338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study examines the perceived needs, experience, and satisfaction of informal caregivers (ICGs) in in-hospital settings, related to their involvement in the design and delivery of services together with hospital staff, namely co-production. DESIGN To obtain a picture of current ICG-staff relationship, a multicenter observational study was carried out. Participants were 75 ICGs recruited in five dedicated in-patient neurorehabilitation wards. Participants answered a self-report questionnaire tapping perceived information/communication needs, emotional/social needs, and their satisfaction; family-centered practices implemented by the staff (namely involving practices and cooperative communication); and ICGs' satisfaction with the service. RESULTS Need satisfaction related positively to staff practices aimed at involving IGCs in treatment and training, but not in decision-making. Involving practices concerning treatment also related positively to ICGs' information/communication needs. In addition, the more the staff involved ICGs in decision-making and promoted cooperative communication regarding treatment, the more ICGs felt that their collaboration in the healthcare process was valuable. Finally, all involvement practices and cooperative communication were positively related to ICGs' overall satisfaction with the service. CONCLUSION The results of the study help to identify gaps in meeting ICGs' needs and to promote strategies to implement family participation toward co-production in in-hospital settings.
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Affiliation(s)
- Giovanna Girardi
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | | | | | - Antonio De Tanti
- Istituto S. Stefano Riabilitazione, Centro Cardinal Ferrari, Fontanellato, PR, Italy
| | - Michelangelo Bartolo
- Neurorehabilitation Unit, Department of Rehabilitation, HABILITA Zingonia, Bergamo, Italy
| | - Domenico Intiso
- UOC di Medicina Fisica e Riabilitativa, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy
| | | | - Gabriella Antonucci
- Department of Psychology, Sapienza University of Rome, Rome, Italy.,IRCSS Santa Lucia Foundation, Rome, Italy
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Sousa SMD, Bernardino E, Peres AM, Martins MM, Gonçalves LS, Lacerda MR. The role of nurses in the integration of care for people with chronic noncommunicable diseases. Rev Esc Enferm USP 2021; 55:e20200131. [PMID: 34495207 DOI: 10.1590/1980-220x-reeusp-2020-0131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/21/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To describe the role of nurses in the integration of care for people with chronic noncommunicable diseases. METHOD This was an integrated single-case study conducted with care coordinators and nurses, purposefully selected, with interviews, documentary analysis and computerized files as sources of evidence. Categorical analysis was used based on data organization using MAXQDA® software, version 2018. RESULTS Thirty-four professionals participated. Most of the professionals who held coordination positions were nurses. The categories clinical team integration and care integration and their subcategories increased understanding of the roles of nurses. CONCLUSION The role of nurses in integrating care for people with chronic noncommunicable diseases was mainly focused on coordination of care, which occurred because of the different roles that they play and that give them autonomy to make decisions and place them in the front line to contribute to situations that required assertive attitudes, such as directing users within the care network.
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Affiliation(s)
- Solange Meira de Sousa
- Universidade Federal do Paraná, Programa de Pós-Graduação em Enfermagem, Curitiba, PR, Brazil
| | - Elizabeth Bernardino
- Universidade Federal do Paraná, Programa de Pós-Graduação em Enfermagem, Curitiba, PR, Brazil
| | - Aida Maris Peres
- Universidade Federal do Paraná, Programa de Pós-Graduação em Enfermagem, Curitiba, PR, Brazil
| | - Maria Manuela Martins
- Universidade Federal do Paraná, Programa de Pós-Graduação em Enfermagem, Curitiba, PR, Brazil
| | | | - Maria Ribeiro Lacerda
- Universidade Federal do Paraná, Programa de Pós-Graduação em Enfermagem, Curitiba, PR, Brazil
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Abstract
Introduction and Aim: There are four quality paradigms, of which the Empirical and Reference paradigm fit best in stable circumstances, and the Reflective and Emergence paradigms, which fit best in unstable circumstances. This study aims to explore the use of the four quality paradigms in integrated care, and to shed light on the different paradigmatic commitments and different perspectives on quality. Methods: Peer-reviewed articles from the International Journal of Integrated care published between January 2015 and December 2019 were included in this study. For each article was determined in which paradigm it belonged. Additionally, the role of the patient and domain of impact in research, policy or practice in relationship to the paradigms were investigated. Results: In total, 255 articles were assessed based on the four quality paradigms. 55 (21.6%) of the articles were placed in the Empirical paradigm, 147 (57.6%) in the Reference paradigm and 45 (17.6%) in the Reflective paradigm. The Emergence paradigm occurred the least (n = 8, 3.1%). Discussion and conclusion: Of all reviewed studies, 80% were placed in the Empirical and Reference paradigm. This raises the question if the used research approaches are consistent with the complexity and contexts in the field of integrated care and support a personalised care approach. More awareness of all four paradigms and reflection on the used epistemologies is needed.
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Massaro M, Tamburro P, La Torre M, Dal Mas F, Thomas R, Cobianchi L, Barach P. Non-pharmaceutical Interventions and the Infodemic on Twitter: Lessons Learned from Italy during the Covid-19 Pandemic. J Med Syst 2021; 45:50. [PMID: 33675427 PMCID: PMC7936238 DOI: 10.1007/s10916-021-01726-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 02/18/2021] [Indexed: 11/29/2022]
Abstract
The COVID-19 pandemic changed expectations for information dissemination and use around the globe, challenging accepted models of communications, leadership, and social systems. We explore how social media discourse about COVID-19 in Italy was affected by the rapid spread of the virus, and how themes in postings changed with the adoption of social distancing measures and non-pharmaceutical interventions (NPI). We used topic modeling and social network analysis to highlight critical dimensions of conversations around COVID-19: 1) topics in social media postings about the Coronavirus; 2) the scope and reach of social networks; and 3) changes in social media content as the nation moved from partial to full social distancing. Twitter messages sent in Italy between February 11th and March 10th, 2020. 74,306 Tweets sent by institutions, news sources, elected officials, scientists and social media influencers. Messages were retweeted more than 1.2 million times globally. Non-parametric chi-square statistic with residual analysis to identify categories, chi-square test for linear trend, and Social Network Graphing. The first phase of the pandemic was dominated by social media influencers, followed by a focus on the economic consequences of the virus and placing blame on immigrants. As the crisis deepened, science-based themes began to predominate, with a focus on reducing the spread of the virus through physical distancing and business closures Our findings highlight the importance of messaging in social media in gaining the public's trust and engagement during a pandemic. This requires credible scientific voices to garner public support for effective mitigation. Fighting the spread of an infectious disease goes hand in hand with stemming the dissemination of lies, bad science, and misdirection.
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Affiliation(s)
- Maurizio Massaro
- Dipartimento di Management, Università Ca' Foscari, Venice, Italy
| | | | - Matteo La Torre
- Dipartimento di Economia, Università G. d'Annunzio, Chieti-Pescara, Italy
| | - Francesca Dal Mas
- Ipazia Observatory on Gender Research, Rome, Italy
- Lincoln International Business School, University of Lincoln, Lincoln, UK
| | - Ronald Thomas
- Department of Pediatrics, School of Medicine, Central Michigan University, Mt Pleasant, MI, USA
| | - Lorenzo Cobianchi
- Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche, Università degli Studi di Pavia, Pavia, Italy.
- Dipartimento di Scienze Chirurgiche, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Paul Barach
- Wayne State University School of Medicine, Detroit, MI, USA
- Jefferson College of Population Health, Philadelphia, PA, USA
- Sigmund Freud University, Vienna, Austria
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Robert G, Williams O, Lindenfalk B, Mendel P, Davis LM, Turner S, Farmer C, Branch C. Applying Elinor Ostrom's Design Principles to Guide Co-Design in Health(care) Improvement: A Case Study with Citizens Returning to the Community from Jail in Los Angeles County. Int J Integr Care 2021; 21:7. [PMID: 33613139 PMCID: PMC7879991 DOI: 10.5334/ijic.5569] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/18/2020] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Increased interest in collaborative and inclusive approaches to healthcare improvement makes revisiting Elinor Ostrom's 'design principles' for enabling collective management of common pool resources (CPR) in polycentric systems a timely endeavour. THEORY AND METHOD Ostrom proposed a generalisable set of eight core design principles for the efficacy of groups. To consider the utility of Ostrom's principles for the planning, delivery, and evaluation of future health(care) improvement we retrospectively apply them to a recent co-design project. RESULTS Three distinct aspects of co-design were identified through consideration of the principles. These related to: (1) understanding and mapping the system (2) upholding democratic values and (3) regulating participation. Within these aspects four of Ostrom's eight principles were inherently observed. Consideration of the remaining four principles could have enhanced the systemic impact of the co-design process. DISCUSSION Reconceptualising co-design through the lens of CPR offers new insights into the successful system-wide application of such approaches for the purpose of health(care) improvement. CONCLUSION The eight design principles - and the relationships between them - form a heuristic that can support the planning, delivery, and evaluation of future healthcare improvement projects adopting co-design. They may help to address questions of how to scale up and embed such approaches as self-sustaining in wider systems.
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Affiliation(s)
- Glenn Robert
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, UK
- The Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Sweden
| | - Oli Williams
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, UK
| | - Bertil Lindenfalk
- The Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Sweden
| | | | | | - Susan Turner
- University of North Carolina, Chapel Hill, United States
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Crocker H, Kelly L, Harlock J, Fitzpatrick R, Peters M. Measuring the benefits of the integration of health and social care: qualitative interviews with professional stakeholders and patient representatives. BMC Health Serv Res 2020; 20:515. [PMID: 32505181 PMCID: PMC7275591 DOI: 10.1186/s12913-020-05374-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 05/27/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Integrated care has the potential to ease the increasing pressures faced by health and social care systems, however, challenges around measuring the benefits for providers, patients, and service users remain. This paper explores stakeholders' views on the benefits of integrated care and approaches to measuring the integration of health and social care. METHODS Twenty-five semi-structured qualitative interviews were conducted with professional stakeholders (n = 19) and patient representatives (n = 6). Interviews focused on the benefits of integrated care and how it should be evaluated. Data was analysed using framework analysis. RESULTS Three overarching themes emerged from the data: (1) integrated care and its benefits, with stakeholders defining it primarily from the patient's perspective; (2) potential measures for assessing the benefits of integration in terms of system effects, patient experiences, and patient outcomes; and (3) broader considerations around the assessment of integrated care, including the use of qualitative methods. CONCLUSIONS There was consensus among stakeholders that patient experiences and outcomes are the best measures of integration, and that the main measures currently used to assess integration do not directly assess patient benefits. Validated health status measures are readily available, however, a substantial shift in practices is required before their use becomes commonplace.
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Affiliation(s)
- Helen Crocker
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK.
| | - Laura Kelly
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK.,Harris Manchester College, Oxford, OX1 3TD, UK
| | - Jenny Harlock
- Health Sciences, University of Warwick, Coventry, CV4 7AL, UK
| | - Ray Fitzpatrick
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Michele Peters
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK
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Abstract
For organising person entered care, an important issue is how to deal with scale. This addresses what to organise on what level (in the neighbourhood, local, in the region, or national). With the increasing complexity of organising integrated care in networks, scale issues are an ingredient of integrated care governance. However, there is a lack of empirical studies that treat scale as an object of study in itself. Scale is an outcome of the interplay between many different interests, values and perceptions of people involved in the broader social and political processes. Five factors for suitable scales are discussed, emphasising the relevance for integrated care governance. These factors show, that the classical micro-meso-macro thinking oversimplify reality and more knowledge about suitable scales is required.
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