Six lessons for successful care coordination
The healthcare landscape is changing. The number of people who rely on the healthcare system due to chronic and/or complex needs is increasing. People stay longer at home and go home as soon as possible when they’re admitted to a hospital. In addition, technological advances and health consumerism lead to a changing demand for care. As a result care tasks are shifting. We refer to this as “substitution of care” or “care coordination”. In practice, however, many substitution projects seem to fail. In this blog, we tell you what is needed to achieve a successful implementation of care coordination initiatives.
What is care coordination?
Coordination of care is defined as: “the organization of patient care activities between two or more participants to facilitate the appropriate delivery of healthcare services. This includes the marshalling of resources needed to carry out all required patient care activities, and is often managed by the exchange of information among participants responsible for the different aspects of care.” In practice, this means a shift, whereby low-complex care is provided within primary care and high-complex specialized care within a hospital. Coordination of care can be organized in a variety of ways: from medical specialists who do consultations in a local community to scaling up and specializing hospitals. And nurse practitioners who take over certain tasks from the GP or medical specialist to tele-consulting between GPs and medical specialists. There are plenty of initiatives, but the majority of them fail. It turns out to be a huge struggle to realise coordinated care in practice.
Why does 80% of the initiatives fail?
Most of the initiatives fail because the complexity of healthcare is not sufficiently recognized. Healthcare is not similar to a car factory. It is a market where life and death are concerned and where various parties with different interests look at problems and solutions from their own perception. Healthcare comprises many elements between which many relationships exist. As a result, problems often have multiple causes at the same time, and everything intervenes. This means that if you cut part of the budget for practice A, this can then lead to a cost increase for practice B. A consequence often not foreseen because a clear overview is missing and the issue is tackled from a silo organisational perspective. This is also apparent from research. Studies show that common bottlenecks are: a lack of understanding of the problem at stake, a lack of a comprehensive vision, no common language, neglecting key interests of parties, and no alignment of strategy, innovation and change management approach. These are all necessary to successfully break down the barriers of fragmented funding, legislation, and data management.
Six lessons for success
There are six main lessons that can significantly improve the success of care coordination in practice.
Lesson 1: Regulating is fragmenting
“We set a policy, and then it is settled” is what often happens. But if there is anything we do not succeed in, it is creating inter-sectorial policies. Policy sectarianism leads to fragmentation and often to failure. Instead, we must strive for an integral legislative framework and funding model for the prevention, care and welfare sectors. Healthcare does not become better or more secure if managers and policymakers set more rules, regulate more eagerly, or introduce more IT systems from their own silo perspective. In fact, it is one of the biggest barriers in our current healthcare ecosystem.
Lesson 2: One size fits no one
Successful care coordination projects are tailored by default, with the emphasis on customization. A method that has been developed in the Netherlands and proves to be successful there, cannot simply be copied in the United States. All successful improvement processes need to be adapted to the local contexts and organizational culture. It is this “couleur locale” that determines whether a care coordination project becomes a success, or a fiasco.
Lesson 3: Leverage the intrinsic motivation of healthcare professionals
Innovation must come from the primary process, because otherwise the chance to succeed is nil. When policymakers set change processes in motion, they rarely connect with the world of healthcare professionals. For example, explore with a physician how more time can be realised during the consultation hour, by eliminating wasteful and time-consuming processes. Then you actually motivate physician to realize care coordination in practice. By taking the drive of the healthcare professional into account, you increase the chance of success of care coordination projects. Policy changes never have the same impact as changes arising from clinical practice.
Lesson 4: Crack the black box
International research shows that successful change processes are based on small scale, cooperation, data integration and a thorough patient empowerment process. The trick is to crack the black box. In other words: dividing a successful initiative into small pieces – the magical ingredients that have caused success – and translate them into a different context. The patient forms the centre and each participant takes on the role that belongs to him or her. That is to say: the care provider for what he is trained, the patient as a manager of his own health and policymakers creating the right enabling conditions.
Lesson 5: Small is great
Practice shows that initiatives on a large scale sometimes have little or no effect, while small initiatives may produce unexpected outcomes. So, start small with a care coordination approach, but have a broader execution plan ready at the start. Consider three implementation strategies in advance. If the first fails, you can immediately switch to the second. And create an integrated business case in which you determine the financial effects for each (business)partner and also determine the social return on investment.
Lesson 6: Embrace a new approach
Perhaps the most important lesson is that we need to embrace a new way of working, recognizing the complexity of care systems and understanding that change is unpredictable and takes time. The process is often tortuous and requires customization by default. For this, we need smart, creative people who can think out-of-the-box and are able to connect the different dots within a complex healthcare system. People who look through the layers and oversee the relationships between processes. This can help us to initiate changes that benefit all parties involved and thus lead to success.
Download our whitepaper “Value-based healthcare: A call for integrated action” to learn what further steps are needed to make care coordination a success.